ID Take two (Part 1) Flashcards
Gram Positive Cocci
Clusters: Staphylococcus (MSSA, MRSA)
Pairs/Chains: Strep Pneumonia, Streptococcus, Enterococcus
Gram Positive Rods
Listeria
Corynebacterium
Gram Positive Anaerobes
Peptostreptococcus
Propionibacterium
C. diff
Clostridium
Atypical Organisms
Chlamydia
Legionella
Mycobacterium TB
Mycoplasma Pneumonia
Gram Negative Cocci
Neisseria
Gram Negative Rods: Curved or Spiral
H pylori
Camplyobacter
Borrelia
Treponema
Gram Negative Rods: Non Gut Colonizing
Pseudomonas aeruginosa
Haemophillus Influenza
Providencia
Gram Negative Rods: Gut Colonizing
E.Coli
Proteus Mirabillis
Klebsiella
Serratio
Enterobacter Cloacae
Citrobacter
Gram Negative Anaerobes
Bacteroids Fragillis
Prevotella
Gram Negative Coccobacilli
Acinetobacter
Bordetella Pertussis
Moraxella
name the four different antibiotic resistance types
Intrinsic - natural
Selection Pressure - removes the good
Acquired
Enzyme Inactivation
ESBL, CRE
Common Resistant Pathogens
Kill Each And Every Strong Pathogen
K: Klebsiella
E: E.Coli
A: Acinetobacter
E: Enterococcus (VRE, CRE)
S: Staphylococcus
P: Pseudomonas aeruginosa
sulfonamides MOA
Folic Acid Inhibitors
(sulfonamides have an S, A, I in name)
Dapsone MOA
Folic Acid Inhibitors
Trimethoprim MOA
Folic Acid Inhibitor
Beta Lactams and Monobactams MOA
Cell Wall Inhibitors
Vancomycin
Dalbavancin
Telvancin
Oritavancin
MOA
Cell Wall Inhibitors
Protein Synthesis Inhibitors
AMG
Macrolides
Tetracyclines
Clindamycin
Linezolid
Quinupristin
Metronidazole and Tinidazole MOA
DNA/RNA inhibitors
Quinolones MOA
DNA/RNA Inhibitors
Inhibit DNA topoisomerase IV and DNA Gyrase
Rifampin MOA
DNA/RNA inhibitor
Cell Membrane Inhibitors
Polymyxins
Daptomycin
Telavancin + Oritavancin = Also cell wall inhibitors
Natural PCN cover: Gram Positive (Streptococcus, Enterococcus)
What Agents are those?
PCN VK (tab/susp)
PCN G Aqueous - IV
PCN G Benzathione (Bicillin LA)
IM!!!!! IV has BBW for Cardio tox
Antistaphylococcal PCN Cover: Streptococcus and MSSA
They have NO RENAL ADJUSTMENTS
WHAT AGENTS ARE THOSE?
Dicloxacillin
Oxacillin
Nafacillin
- IV Vesicant: Need cold compress and Hyaluronidase
AminoPCN cover: Streptococcus, Enterococcus, And Postive Anaerobes
WHEN paired with BLI: MSSA, Gram Negatives (HNPEK), and Gram negative anaerobes
WHAT AGENTS ARE THOSE?
Amoxicillin –> Augmenting (14:1)
Ampicillin –> Unasyn
PO has ass bioA
CI: history of cholestatic jaundice or hepatic dysfunction
CrCl < 30 = NO ER Formulation or 875 mg of Augmentin
Ampicillin requires NS for dilution
Extended Spectrum PCN cover: Streptococcus, Enterococcus, Mouth Flora, Gram Neg (HNPEK), Gram Neg Anaerobes, CAPES (gram negatives), Pseudomonas!!!
WHAT AGENTS?
Zosyn (pipperacillin/tazobactam)
As a class, PCN have what SE and what DDI?
Seizures that occur with accumulation, GI uses, diarrhea, rash, hemolytic anemia
Probenecid = Increase BL Levels
1st Generation Cephalosporins: Gram + (Preferred agent for MSSA if a cephalosporin is used), Gram - (PEK)
WHAT AGENTS
Cefazolin
Cephalexin (Keflex): 250 - 500 mg Q6-12H
Cefadroxil
Common uses: MSSA and Strep
2nd Generation Cephalosporins:
Streptococcus Pneumonia, HNPEK
Cefotetan + Cefoxitin have additive effects with Anaerobes (B.frag)
NAME THE AGENTS
Cefuroxime
Cefotetan (Cefotan)
Cefactor, Cefoxitin, Cefprozil
Cefotetan Has What Side Chain?
NMTT or 1-MTT and increased bleeding and can cause disulfiram like rxn with EtOH
3rd Gen Group 1 cephalosporins: Streptococci, MSSA, HNPEK, Gram + Anaerobes
WHAT AGENTS ARE THESE?
Cefdinir
Cefotaxime
Ceftriaxone - No renal Adjustments, CI hyperbilirubinemia, in neonates do not use with Ca containing products if <28 d old. Precipitates form
Cefditonen, Cefixime (Suprax), Cefpodoxime, Ceftibuten
3rd Generation Group 2 Cephalosporins: Lack gram positive activity but covers PSEUDOMONAS
WHAT AGENTS ARE THESE?
Ceftazidime - Fortaz
+ Avibactam = Avycaz (Some CRE activity)
4th generation Cephalosporins: Broad Gram “-“ coverage
(HNPEK, CAPS, Pseudomonas)
WHAT AGENTS
Cefepime
5th Generation Cephalosporin: HNPEK, MRSA, Broad Gram + Coverage
What agents???
Ceftaroline (teflaro)
Other than Avycaz what other Cephalosporin has a BL-I added to it?
Ceftolozane/Tazobactam (Zerbaxa)
Similar to gen 3 group 2 + MDR Pseudomonas, MDR gram “-“ rods
Hydrophilic Agents!
-Small Vd
- Renal Elimination
- Low Intracellular Conc
- increased Cl +/- distribution in sepsis
- Poor BioA
What agents!!!
BL
AMG
Vanco
Dapto
Polymyxins
Lipophilic Agents!
- Large Vd
- Hepatic Metabolism
- good with atypical
- CL +/- distribution minimally changes in sepsis
- IV: Po is usually 1:1
What agents!!!
Quinolones
Macrolides
Tetracyclines
Rifampin
Linezolid
Cmax: MIC (Conc. Dependent)
AMG
Quinolones
Daptomycin
(large doses with long intervals)
AUC: MIC (exposure dependent)
Vancomycin, Macrolides, Tetracyclines, Polymyxins
Time > MIC (time dependent)
Beta Lactams
Carbapenems - reserved for MDR Gram Negative agents (ESBL, No coverage with MRSA, VRE, Atypical
No PCN allergies!
Accumulation leads to seizure + confusion
DRESS
Decrease VPA
Doripenem
Imipenem/Cilastatin
Meropenem!!!
ErtAPenem (INVANZ)
PEA: no pseudomonas, enterococcus, acinetobacter Stable in NS ONLY
Imipenem has the highest seizure risk
Monobactams - Aztreonam
Used when BL allergy is present
Many gram “-“ (Pseudomonas)
NO GRAM POSITIVE or anaerobic activity
PEK
HNPEK
CAPES
Pseudomonas
Aminoglycosides (Cover gram “–” pseudomonas included )
Extended interval OVERVIEW
uses higher doses to attain higher peaks and gives less accumulation, less nephrotoxin risk, more cost effective
4-7 mg/kg/dose, frequency is determines by a monogram
(gentamicin, tobramycin, amikacin)
Aminoglycosides (Cover gram “–” pseudomonas included)
Traditional Dosing
IBW! if overweight then use AjBW, If underweight use TBW
obtain peak and trough in regards to 4th dosing
Gentamycin and Tobramycin 1-2.5 mg/kg/dose
Trough: <2 mcg/mL, Synergy < 1mcg/mL
BBW with aminoglycosides
Nephro and Ototoxicity, Neuromuscular blockade + respiratory paralysis should be avoided
CAUTION in elderly, renal impaired, other nephrotoxic drugs
Quinolones
- atypical coverage
- concentration dependent
Levofloxacin, Moxifloxacin, Gemifloxacin = Respiratory (S.Pneu)
Ciprofloxacin and Levofloxacin = Pseudomonas
Delafloxacillin = MRSA (SSTI)
Moxi = No renal adjustments
Quinolones BBW / SE / DDI
BBW: tendon inflammation or rupture, peripheral neuropathy, CNS effects (seizures)
QT prolonging (moxi highest), Hypoglycemia/Hyperglycemia
Avoid in pregnancy/lactation, Kids
Can cause Photsensitivity
DDI: antacids + other polyvalent, Lanthanum, Renvela by at least 2 hours
Cipro 1A2 inhibitors = increase theophylline levels
