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Capstone Exam 4 > ID review > Flashcards

ID review Flashcards

1
Q

Which antibiotics cover MRSA? (12)

A
  1. Vancomycin, 2. Linezolid (Zyvox), 3. Tedizolid (Sivextro), 4. Daptomycin (Cubicin) [not for pneumonia], 5. Quinupristin/dalfopristin (Synercid), 6. Tigecycline (Tygacil), 7. Trimethoprim/ Sulfamethoxazole, 8. Minocycline, 9. Doxycycline (if susceptible). 10. Televancin, 11. Dalbavancin (Dalvance), 12. Oritavancin (Orbactiv).
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2
Q

Which drugs cover VRE? (7)

A

Linezolid (Zyvox), Tedizolid (Sivextro), Quinupristin/dalfopristin (Synercid), Daptomycin (Cubicin), Tigecycline (Tygacil), Ampicillin, Nitrofurantoin (UTI- cystitis only watch CrCl)

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3
Q

Which drugs cover Pseudomonas aeruginosa? (14)

A
  1. Pip/tazo, 2. Ticarcillin/Claulanate, 3. Piperacillin, 4. Ceftazidime, 6. Cefepime, 7. Imipenem, 8. Meropenem, 9. Tobramycin, 10. Gentamicin, 11. Amikacin, 12, Cipro, 13. Levo, 14. Aztreonam
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4
Q

Gram positive cocci in chains:

A

Strep

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5
Q

Gram positive cocci in clusters

A

Staph

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6
Q

Anaerobic Gram positive cocci

A

Peptostreptococcul, Peptococcus, Microaerophillic Strep

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7
Q

Gram positive Bacilli

A

Lactobacillus, Clostridium, mycobacterium

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8
Q

Risk factors for community acquired MRSA

A

Skin on skin exposure (athletes, prisoners, sexual activity), Close living quarters, sharing towels/razors, lesion looks like a spider bite. Pacific islanders, Alaskan natives and native Americans at higher risk.

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9
Q

Treatment for mild/moderate community acquired MRSA

A

Clindamycin, Minocycline/Doxycycline, or Sulfatrim

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10
Q

Treatment for moderate to severe Community Acquired MRSA

A

Vancomycin, Linezolid, Daptomycin, Quinupristin/ Dalfopristin (synercid), Tigecycline

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11
Q

Treatment for mild to moderate healthcare associated MRSA

A

Minocycline/doxycycline, Sulfatrim

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12
Q

Treatment for moderate to severe healthcare associated MRSA

A

Vancomycin, linezolid, daptomycin (except pneumonia), Quinupristin/Dalfopristin (Synercid), Tigecycline

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13
Q

Oral treatment for pseudomonas?

A

Cipro, Levo, Carbenicillin (for cystitis only)

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14
Q

Risk factors for multi-drug resistant gram negatives

A

antimicrobial therapy in preceding 90 days, current hospitalization of 5 days or more, high frequency of resistance in hospital or unit, hospitiliation of 2 days or more in previous 90 days, residence in a nursing home, mechanical ventilation greater than 5 days, chronic dialysis within 30 days, home wound care, family member with an MDR pathogen, immunosupressive disease or medication

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15
Q

MOA of fluoroquinalones

A

They are bactericidal via inhibition of topoisomerase II and IV which are esential for duplication, transcription and repair of bacterial DNA.

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16
Q

Types of Beta Lactams

A

Penicillins, Cephalosporins, Carbapenems, Monobactam

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17
Q

MOA of beta lactams

A

Covalently bond penicillin binding protein thereby preventing transpeptidation of peptidoglycan. (break downs the cell wall and leads to cell death)

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18
Q

Are beta lactams time or concentration dependent?

A

Time dependent

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19
Q

How are beta lactams excreted?

A

through the kidneys

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20
Q

Adverse reactions to Beta lactams

A

Neurologic (lowers seizure threshold (PCNs/ carbapenems) Hematologic: neutropenia, thrombocytopenia

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21
Q

MOA of fluoroquinolones

A

inhibit bacterial topo II and topo IV which are essential enzymes for duplication, transcription and repair of bacterial DNA

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22
Q

Fluoroquinolones are time or concentration dependent?

A

Concentration

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23
Q

Which fluoroquinolone penetrates the lungs poorly?

A

Cipro

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24
Q

Which fluoroquinolone penetrates the bladder poorly?

A

Moxi

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25
Q

Which antibiotics bind to the 30s subunit?

A

Tigecycling and tetracyclines

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26
Q

Which antibiotics bind to the 50s subunit?

A

Macrolides and clindamycin

27
Q

Adverse effects seen with tetracyclines and tigecycline?

A

phototox, tooth discoloration <8 y/o, teratogenic after first trimester.

28
Q

Black box warning for tigecycline?

A

all cause mortality.

29
Q

Adverse reactions for fluoroquinolones

A

tendonitis with tendon rupture and Qtc Prolongation

30
Q

Which class of drugs increases INR with warfarin?

A

Fluoroquinolones

31
Q

Are tetracyclines time or concentration dependent?

A

Trick question! They’re both! :D

32
Q

The D test is used to identify possible macrolide-inducible resistance to ________

A

Clindamycin

33
Q

If the disk diffusion assay forms a “D” shape, what does that mean?

A

This means the bug is positive for cross-resistance

34
Q

Macrolides and Clindamycin are _______ dependent

A

Time

35
Q

Adverse effects of macrolides and clindamycin?

A

QTc prolongation and hepatitis. (also C. Diff)

36
Q

Metronidazole brand name and pearl

A

Flagyl, Disulfiram-like interaction with alcohol. also SJS

37
Q

Sulfonamide example and pearl

A

Bactrim, empiric warfarin dose adjustments sometimes required.

38
Q

Aminoglycosides example and pearl

A

Gentamicin, nephrotoxic

39
Q

Which antibiotic may be given as a single dose for UTI?

A

Fosfomycin

40
Q

Adverse effects of vanco

A

Red man syndrome, nephrotoxic

41
Q

Which antibiotic is inactivated by lung surfactant?

A

Daptomycin

42
Q

AE of linezolid?

A

Serotonin syndrome

43
Q

AE of synercid?

A

arthalgias/myalgias

44
Q

Symptoms of otitis media

A

Rapid onset otalgia, fever, dizziness, hearing loss, stiff neck, blood or purulent secretions

45
Q

Most common otitis media pathogens

A

S. pneumoniae, H. influenzia, Moraxella catarrhalis, S. pyogenes

46
Q

For otitis media, which age group ALWAYS gets antibiotics?

A

2 months-6 months

47
Q

A 3 year old has certain otitis media. Should she get an antibiotic?

A

Only if it is severe.

48
Q

What is the recommended treatment for otitis media/

A

Amoxicillin or Amoxicillin/clavulanate

49
Q

Duration of otitis media treatment?

A

< 2 y/o (10 days), 2-5 y/o (5 days), > 6 y/o (5-7 days)

50
Q

When is a UTI uncomplicated?

A

When it is a female aged 15-45 with no structural or functional abnormalities

51
Q

Which drugs are preferred for uncomplicated UTI?

A

Bactrim DS 1 BID x14,

Cipro 500 BID x 7, Levo 750 QD x 5

52
Q

SIRS criteria

A

temp >38 (100) or < 36 (96.8), HR > 90, RR > 20 (or PaCo2 < 32 torr), WBC > 12 or 10% bands)

53
Q

Recommended treatment duration for cellulitis?

A

5 days (if improvement)

54
Q

inpatient criteria for diabetic foot infection

A

severe, or mild with PAD, or poor support at home. Unable to comply with outpatient treatment, failure to improve in outpatient setting.

55
Q

When do you cover for MRSA in diabetic foot infection?

A

History of MRSA in past year, local prevalance is high, infection sufficiently severe enough that failing to empirically cover MRSA would be an unacceptable risk.

56
Q

When do you cover for pseudomonas in diabetic foot infection?

A

Severe infection, feet soaking history, warm climate countries, previously failed therapy with an antipsuedomonal therapy.

57
Q

Which antibiotics should be used for mild DFI without risk of MRSA?

A

Clindamycin, Cephalexin, Levofloxacin

58
Q

Which antibiotics should be used in mild DFI with possibility of MRSA?

A

Doxy, Sulfatrim

59
Q

Which antibiotic for moderate or severe Non-MRSA DFI?

A

ampicillin-sulbactam, ertapenem, imipenem-cilastin

60
Q

moderate to severe DFI with MRSA risk?

A

Vanco

61
Q

Moderate to severe MRSA with pseudomonas risk?

A

Pip/tazo

62
Q

moderate to severe with MRSA and pseudomonas risk?

A

Carbapenem

63
Q

antibiotic duration in DFI

A

1-4 weeks depending on severity.

Capstone Exam 4 (3 decks)

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