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cobbled-together pre-mcc review > id quick > Flashcards

id quick Flashcards

1
Q

If you see gram positive cocci in clusters, think…

A

Staphylococcus (MSSA, MRSA)

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2
Q

If you see gram positive cocci in pairs and short chains, think…

A

Streptococci, enterococci

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3
Q

If you see gram positive bacilli, think…

A

Listeria, Corynebacterium, Clostridium

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4
Q

If you see gram negative bacilli, think…

A

Enterobacteriacea (E. coli, Klebsiella, Enterobacter)

Pseudomonas, Stenotrophomonas

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5
Q

If you see gram negative coccobacilli, think…

A

H. influenzae, Pasturella, Brucella

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6
Q

If you see gram negative diplococci, think…

A

Neisseria, Moraxella, Acinetobacter

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7
Q

What flora are normally found on human skin?

A 
Staphylococcus aureus (MSSA, MRSA)
Streptococcus pyogenes (Group A streptococcus)
Staphylococcus epidermidis (CNST)
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8
Q

What flora are normally found in human nasopharynx?

A

Streptococcus pneumoniae
Hemophilus influenzae
Moraxella catarrhalis
Streptococcus pyogenes

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9
Q

What flora are normally found in human oropharynx?

A 
Peptococcus
Peptostreptococcus
Streptococci (viridans)
Fusobacterium
Eikenella
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10
Q

What flora are normally found in distal human GI tract?

A 
Escherichia coli
Several species in each of these classes:
• Klebsiella
• Proteus
• Enterococcus
• Bacterioides
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11
Q

What flora are normally found in human urinary tract?

A

Escherichia coli
Klebsiella
Enterococcus species

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12
Q

What species are commonly resistant to penicillin based on their production of beta-lactamases?

A

E. coli, Klebsiella spp, H. influenzae & M. cattarhalis

Note: if just beta lactamase, carbapenems still work

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13
Q

What does spp mean wrt Abx?

A

several species

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14
Q

Which organisms most commonly produce carbapenemases?

A

Pseudomonas, E.coli, Klebsiella, and Acinetobacter spp.

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15
Q

What are the members of the beta lactam family?

A

Penicillins, cephalosporins, and carbapenems

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16
Q

How do beta lactam Abx work? (MOA, properties)

A

Cell wall-active agents
Bactericidal
Time-dependent killing

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17
Q

Name some penicillins

A
  • penicillin V & penicillin G
  • ampicillin (IV) & amoxicillin
  • amoxicillin – clavulanic acid
  • cloxacillin
  • piperacillin - tazobactam

So note: piptazo and amoxclav are still penicillins, they just have an add-on beta-lactamase-inhibitor, which counteracts the main mechanism of bacterial resistance

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18
Q

What is Pen G/V useful against?

A

Narrow spectrum agent; mostly aerobic gram positive cocci

Beta-hemolytic strep (group A, B, C, G)
Tremponema pallidum (Syphillis)

Also: n. meningitidis, though some resistance
oral anaerobes
enterococcus

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19
Q

What is Pen G/V NOT useful against?

A

most gram negative organisms

beta-lactamase producing organisms (S. aureus - ~90%)

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20
Q

What are amoxicillin/ampicillin useful against?

A

narrow spectrum agent; mostly Gram positive aerobes, some Gram
negative aerobes

Everything Penicillin does plus: HiPEEL:

  • H. influenzae (~25% resistance)
  • Proteus mirabilis
  • E. coli (~30% resistance)
  • enterococcus (E.faecalis vs. penicillin)
  • Listeria monocytogenes (HiPEEL)
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21
Q

What is Amox-Clav useful for?

A

Amoxicillin + ß-lactamase inhibitor
– broad-spectrum agent
– extends spectrum of amoxicillin to cover more gram negatives (E.coli, H. influenzae, Salmonella, Shigella) + gut anaerobes (B. fragilis)

Note: does NOT cover pseudomonas

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22
Q

What is Pip-Tazo useful for?

A

Most broad-spectrum penicillin; aerobic Gram positives (including MSSA, E. faecalis), difficult aerobic Gram negatives (including Enterobacter, Klebsiella, Serratia, Pseudomonas, Acinetobacter), anaerobes (including B. fragilis)

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23
Q

What is cloxacillin useful for?

A

Drug of choice for MSSA; otherwise pretty narrow spectrum, not widely used

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24
Q

What is important to know about the cephalosporins re MOA and gram +/- activity?

A

beta lactams

generally, earlier gen better gram + worse gram - and later gen worse gram + better gram -

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25
Q

Name 1st gen cephalosporins

A

cefazolin
cephalexin
cefadroxil

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26
Q

What are 1st gen cephalosporins useful for?

A

Narrow spectrum:
– aerobic gram positives (MSSA, ß-hemolytic Streptococcus)
– Some aerobic gram negatives (PEcK: Proteus, E.coli,
Klebsiella)
– oral anaerobes

NOT for enterococci, gut anaerobes

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27
Q

Name 2nd gen cephalosporins

A

cefuroxime, cefaclor, cefprozil, cefoxitin

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28
Q

What are 2nd gen cephalosporins useful for?

A

Oral stepdown therapy for CAP!

“Middle of the road” coverage
• Covers [almost] everything that 1st generations cover:
– Gram positives: MSSA, Streptoccocus (↓activity vs. 1st generation)
– Gram negatives: PEcK + H. influenzae & Moraxella
– oral anaerobes, NOT gut anaerobes
*exception: cefoxitin – poor Gram positive coverage; covers B. fragilis (but
resistance ~20%)

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29
Q

Name 3rd gen cephalosporins

A

ceftriaxone, cefotaxime, ceftazidime

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30
Q

What are 3rd gen cephalosporins useful for?

A

ceftriaxone and cefotaxime:
Broad-spectrum
• Gram positive coverage: MSSA (reasonable coverage), Streptococcus (excellent coverage)
• Gram negatives: difficult to kill Gram negatives (Serratia, Enterobacter, Citrobacter), N.menigitidis, N.gonnorhea (ceftriaxone)
• oral anaerobes

NOT: enterococcus, pseudomonas, gut anaerobes

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31
Q

What is ceftazidime useful for?

A

Pseudomonas!

documented Pseudomonal infections and empiric Gram negative coverage where Pseudomonal coverage is desired

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32
Q

What is ceftriaxone useful for?

A

N. menigitidis, N. gonorrhea

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33
Q

Name 4th gen cephalosporins

A

cefepime (trick Q, there’s only 1 of them!)

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34
Q

What are 4th gen cephalosporins useful for?

A

treatment of documented Pseudomonal infections, empiric Gram negative
coverage where Pseudomonal coverage is desired

broad-spectrum
• Like ceftriaxone, but:
– Gram positives: better activity vs. MSSA
– Gram negatives: Pseudomonas

Remember, it’s JUST cefepime

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35
Q

What are the carbapenems?

A
  • Ertapenem
  • Meropenem
  • Imipenem-cilastin
  • Doripenem
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36
Q

Generally, what are carbapenems useful for?

A 
“Tanks” of the ß-lactams
• Extremely broad-spectrum:
- most aerobic Gram positives
- most aerobic Gram negatives- including ESBLs!!!
- most anaerobes
- Drugs of choice for ESBLs

Reserve for serious infections with resistant organisms!

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37
Q

What are ESBLs?

A

Extended Spectrum Beta Lactamase bacteria produce an enzyme that can break down commonly used antibiotics

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38
Q

Name the fluroquinolones

A

– ciprofloxacin
– levofloxacin
– moxifloxacin

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39
Q

How do the fluoroquinolones work?

A

MOA: inhibit DNA gyrase – inhibit DNA replication

Bactericidal
Concentration-dependent killing

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40
Q

What is ciprofloxacin useful for?

A

aerobic gram negatives (Pseudomonas if susceptible; increasing resistance)

NOT useful for: gram positive or anaerobic infections

41
Q

What are levofloxacin and moxifloxacin useful for?

A

aerobic gram positives/Gram negatives, atypicals
Classic indication: CAP
eg atypicals: Chlamydia, Mycoplasma, Legionella
NOT useful for: MRSA, enterococcus

Note: some differences, eg pseudomonas levo is better, gut anaerobes moxi is better

42
Q

Name the aminoglycosides

A

– tobramycin
– gentamicin
– amikacin

43
Q

How do aminoglycosides work?

A 
Antimicrobial Properties
– bactericidal
– concentration-dependent killing
Mechanism of Action:
– inhibit 30S ribosomal unit – inhibit protein synthesis
44
Q

What are aminoglycosides useful for?

A
  • Narrow spectrum; aerobic gram negatives only (including ESBLs)
  • Can be used for synergy with a ß-lactam against Gram positives (streptococci, enterococci)

Useful for: aerobic gram negatives, ESBLs, Pseudomonas (tobramycin)
Not useful for: gram positives (except synergy with ß-lactams)

• Differences between agents:
– Klebsiella, Serratia: G > T > A
– Pseudomonas: T > G >A
– Amikacin has lowest resistance; but 4X higher MICs

45
Q

Name the macrolides

A

– erythromycin
– azithromycin
– clarithromycin

46
Q

How do macrolides work?

A 
Antimicrobial Properties
– bacteriostatic
– time-dependent killing
Mechanism of Action:
– inhibit 50S ribosomal unit 
– inhibit protein synthesis
47
Q

What are macrolides good for?

A

Relatively broad-spectrum
– Gram positives: Streptococci (note increasing resistance with S. pneumoniae ~20%)
– some Gram negatives (A & C only): H. influenzae, M. cattarhalis
– atypicals
– NO anaerobic coverage

Useful for: Niche: RTIs, Legionella
Not useful for: MRSA, enterococcus

48
Q

What is the PEcK mnemonic for?

A

First gen cephalosporins

PEcK = Proteus, Escherichia coli, Klebsiella

49
Q

What is the most common pathogen in acute rhinitis?

A

Viral (rhinovirus, coronavirus, influenza, RSV, parainfluenza, adenovirus)

50
Q

What is the Abx for acute rhinitis?

A

None – viral

51
Q

What is the most common pathogen in pharyngitis?

A

Viral (rhinovirus, coronavirus, influenza, parainfluenza, adenovirus, coxsackievirus)

52
Q

What is the most common pathogen for strep pharyngitis?

A

Group A beta-hemolytic streptococcus

53
Q

What is first-line for treating strep pharyngitis?

A

Children and adults: penicillin

Erythromycin 2nd line for both

54
Q

What are the most common pathogens for sinusitis?

A

S. pneumoniae
H. influenzae
M. catarrhalis
S. aureus

55
Q

What is first-line for treating sinusitis?

A

Children and adults: amox

2nd line for both: amox-clav

56
Q

What organisms cause Acute Otitis Media?

A 
S. pneumoniae 
H. influenzae 
M. catarrhalis 
Group A Strep 
S. aureus
57
Q

Rx for acute OM

A

if treating:

amox, then amox-clav (both adult and ped)

58
Q

Otitis externa: organisms

A

P. aeruginosa
Coliforms
S. aureus

59
Q

Otitis externa: Rx

A

Cortisporin® otic solution 4 drops tid or qid (3 drops tid or qid for children) TM defect: Ciprodex® otic suspension 4 drops bid x 5 d
Necrotizing (i.e. bone involvement): ciprofloxacin 750 mg PO bid x 4-8 wk

60
Q

Bronchitis: organisms

A

viral

61
Q

Bronchitis: Tx

A

None – viral

62
Q

Pneumonia: CAP, no comorbidity: organisms

A

S. pneumoniae
M. pneumoniae
C. pneumoniae

63
Q

Pneumonia: CAP, no comorbidity: Rx

A 
First line:
Amoxicillin
erythromycin
clarithromycin
azithromycin
64
Q

Pneumonia: CAP, with comorbidity: organisms

A

S. pneumoniae
M. pneumoniae
C. pneumoniae
H. influenzae

65
Q

Pneumonia: CAP, no comorbidity: Rx

A

amox, amox/clav, cefuroxime, cefprozil
PLUS clarithromycin, azithromycin, doxycycline
OR levofloxacin, moxifloxacin [unclear if these are solo or adjunct to line 1]

66
Q

Dental infections: Rx

A

penicillin or clindamycin

67
Q

Diarrhea: organisms?

A

Enterotoxigenic E. coli (ETEC) Campylobacter
Salmonella
Shigella
Viruses Protozoa

68
Q

Diarrhea: Rx?

A

symptomatic if mild

If mod-severe: fluoroquinolones (olfloxacin, norfloxacin, ciprofloxacin, levofloxacin)
If kids: Azithromycin – safe, tolerable, easily administered

If coming from south/southeast Asia, may have quinolon-resisitant campylobacter: use azithromycin

69
Q

Diarrhea post-Abx: organisms?

A

C difficile

70
Q

Diarrhea post-Abx: Rx?

A

mild-moderate: metronidazole

Severe (WBC≥15, Cr ≥1.5x baselin): vancomycin

71
Q

Peptic ulcer disease (non-NSAID): organism?

A

H pylori

72
Q

Peptic ulcer disease (non-NSAID): Rx?

A

First line:
PPI + amox + clarithromycin
Or
PPI + metronidazole + clarithromycin

73
Q

Vulvovaginal candidiasis: Rx?

A

fluconazole orally
miconazole intravaginal
Other -azole tx available OTC

74
Q

Bacterial vaginosis: organisms?

A

Overgrowth of:
G. vaginalis
M. hominis
Anaerobes

75
Q

Bacterial vaginosis: Rx?

A

first line: metronizadole PO; metronidazole or clindamycin intravaginally

76
Q

In which patients would you treat asymptomatic BV?

A

high-risk pregnancy, prior IUD insertion, gynecologic surgery, induced abortion, or upper tract instrumentation

77
Q

HSV: Rx?

A

First and recurrent episodes: acyclovir, famiciclovir, valacyclovir
Can do prophylaxis in pregnancy starting at 36w

78
Q

Gonorrhea/Chlamydia: Rx?

A

ceftriaxone 250 mg IM x 1 dose + azithromycin 1 g PO single dose
or
doxycycline 100 mg PO bid x 7 d

79
Q

Mastitis: organisms?

A

S. aureus

S. pyogenes

80
Q

Mastitis: Rx?

A

cloxacillin

cephalexin

81
Q

Tinea Cruris/Pedis (jock itch/athlete’s foot): organism?

A

clotrimazole

ketoconazole

82
Q

Cellulitis (uncomplicated): organisms?

A

S. aureus

Group A Streptococcus

83
Q

Cellulitis (uncomplicated): Rx?

A

1st line: cephalexin
2nd line: cloxacillin or clindamycin
Note: Tx for 10-14d

84
Q

If ?penicillin allergy: can you use cephalosporins?

A

If rash: cephalosporins OK

If anaphylaxis do NOT use cephalosporins

85
Q

MRSA

A

Vancomycin, Linezolid, Daptomycin

86
Q

Pseudomonas

A

Pip-Tazo, Carbapenems, Cefepime

87
Q

Outpt Pneumonia

A

Doxycycline, Azithromycin, Moxifloxacin

88
Q

Inpt Pneumonia

A

CAP: 3rd gen cephalosporin + Azithromycin
HAP: Vancomycin + Pip-Tazo

89
Q

Neutropenic fever

A

Cefepime (4th gen cephalosporin)

Carbapenems

90
Q

UTI

A

Trimethoprim-sulfamethoxazole, Nitrofurantoin

91
Q

Meningits

A

Vancomycin, Ceftriaxone, +/- steroids, +/- Ampicillin

92
Q

Cellulitis

A

Cefazolin, Trimethoprim-sulfamethoxazole, clindamycin

IV Vancomycin

93
Q

Anaerobe: what’s your strategy?

A

Gut or vagina: metronidazole

Everywhere else: clindamycin

94
Q

Staph: what’s your strategy?

A

Methicillin (eg cloxacillin)
MRSA: Vancomycin
Vancomycin-resistant: Linezolid

95
Q

Gram negatives: what’s your strategy?

A

start with Amoxicillin (with or without clav); don’t cover pseudomonas
If Pseudomonas coverage needed, bump up to Piperacillin-Tazosin

96
Q

Brand names: ancef is …

A

cefazolin

97
Q

Brand names: flagyl is …

A

metronidazole

98
Q

Brand names: Bactrim, Septra is …

A

sulfamethoxazole-trimethoprim

cobbled-together pre-mcc review (3 decks)

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