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Nur 1142 Patho > Infectious disease > Flashcards

Infectious disease Flashcards

1
Q

What are the factors that influence infection

A
  1. Communicability
  2. Infectivity
  3. Virulence
  4. Toxigencity
  5. Pathogenicity
  6. Porter of entry
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2
Q

What does communicability mean in relation to factors that influence infection?

A

Ability to spread from one individual to others and cause disease: measles and pertussis spread very easily; HIV is of lower communicability

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3
Q
  • What is infectivity?
A

Infectivity
Ability of pathogen to invade and multiply in the host, it Involves attachment to cell surface, release of enzymes, escape of phagocytes, spread through lymph and blood to tissues

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4
Q
  • What is virulence
A

Virulence o Capacity of a pathogen to cause severe disease; for example, measles virus is of low virulence while rabies virus

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5
Q
  • What is mean of pathogenicity?
A

: Ability of an agent to produce disease Success depends on communicability, infectivity, extent of tissue damage, and virulence

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6
Q
  • What is toxigenicity?
A

Ability to produce soluble toxins or endotoxins, factors that greatly influence the pathogen’s degree of virulence

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7
Q

What is the Portal of entry

A

Route by which a pathogenic microorganism infects the host
* Direct contact
* Inhalation
* Ingestion
Bites of an animal or insect

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8
Q

What are the characteristics of bacterial infection?

A

Bacteria are prokaryocytes, made up on aerobic or anaerobic

Gram-positive or Gram-negative

Can produce toxins- endotoxins and exotoxins

Bacteremia (presence) or septicemia (growth)

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9
Q
  • What are the toxins produced by bacteria
A

Exotoxins: Enzymes that can damage the plasma membranes of host cells or can inactivate enzymes critical to protein synthesis

Endotoxins: Activate the inflammatory response and produce fever

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10
Q
  • What are viral disease
A

Disease caused by viruses
Viruses Replication depends on ability to infect host cell
Viruses are Simple organism
Usually is self-limiting

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11
Q
  • Whats the mode of transmission of viral infections
A

Aerosol
Infected blood
Sexual contact
Vector

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12
Q
  • What are the systemic approach to Identify the source of infection
A

Underlying conditions/co-morbidity
Where the infection was acquired (community vs. hospital
Risk factors for infection (age, pregnancy, immune compromise, malnutrition, poor sanitation, substandard living conditions, substance use)
Previous antibiotic use (when) last 3 months
Allergies

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13
Q

What is the Gram stain for gram positive and gram negative

A

G +ve blue/purple
G -ve red/ pink

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14
Q

Gram statining

A

Gram +ve bacteria appear purple under a Gram staining due to retention of crystal violet dye in their thick peptidoglycan walls

Gram -ve bacteria appear red and have thinner cell walls

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15
Q

How are bacteria identified

A

Gram straining – G +ve or G -ve
Oxygen utilization- aerobic or anaerobic
Shape- Bacilli= rods = long thin o Cocci = round, oval

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16
Q
  • G -ve bacteria contain lipopolysaccharide (LPS), what is the function of LPS in relation to antibiotic
A

Gram – ve bacteria lipopolysaccharide – is impermeable by penicillin and cephalosporins

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17
Q
  • What group of antibiotics can penetrate lipopolysaccharide
A

broad spectrum penicillin (e,g ampicillin and amoxicillin) and 3rd generation cephalosporins can penetrate the lipopolysaccharide (this coat) – more hydrophilic

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18
Q
  • G -ve bacteria produce an enzyme that inactivate penicillin what the name of the enzyme
A

B-lactamase

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19
Q
  • List common group of G -ve bacteria
A
  1. Enterics (red rods)- GI tract (E. coli) Shigella, Salmonella, Klebsiella, Enterobacter, Serratia, Proteus etc
  2. Hemophilus influenza (red rods_
  3. Neisseria (red rods)
  4. Pseudomonas
  5. others : Clamydia- C. trachomatics, C pneumoniae.
    Others common cause of nosocomial infections
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20
Q
  • What are organisms that causes bacterial meningitis
A

Streptococcus pneumonia,
Neisseria meningitides,
Hemophilus influenzae,
Strep agalactiae,
listeria monocytogens

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21
Q
  • What are organisms that causes otitis media?
A

Streptococcus pneumoniae

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22
Q

What are organisms that causes Community acquired pneumonia

A

o Strep pneumonia
o Hemophylius influenae
o Staph aureus

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23
Q

What are organisms that causes atypical pneumonia

A

o Mycoplasma penumoae
o Chlymeida penumonae
o Legionella penumonia

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24
Q
  • What are organisms that causes pneumonia due to tuberculosis.
A

o Mycobacteria tuberculosis

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25
Q
  • What organisms causes skin infection
A

Staph aureus
Strep pyogenes
Penudomonas aeruginosa

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26
Q
  • What organisms cause STD
A

Clamydia trachomatis
Neisseria gonorrhoes
Traponema pallidiu,
Ureaplasma urelyticu
Hemophilus ducreyi

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27
Q
  • What organism causes UTI?
A

E. coli
Enterobacteriaces
Staph saprophyticus
Peudomonas aeruginosa

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28
Q

What organism causes food poisoning?

A

Campylobacter jejuni
Salmonella
Shigella
Clostridium
Staph aureus

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29
Q

what organism causes gastritis?

A

H. pylori?

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30
Q

What organism causes upper respiratory tract infection?

A

Strep pyogenes
Haemophilus influenzas

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31
Q
  • What organisms causes sinusitis
A

Steph pneumonia
H. influenzas

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32
Q

what organism causes eye infections

A

S. aureaus
N. gonoereahoe
c. Trachomatis

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33
Q

What are the class of antibiotics

A

B lactams (penicillin/cephalosporins/carbapenems/monobactams)
Macrolides
Quinolones
Aminoglycosides
Sulfonamides
Tétracyclines
Nitrofurantion/fosfomucin
Lincosamide (Clindamycin)

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34
Q
  • What are the classes of antifungi?
A

Polyenes
Anitmetabolites
Azoles
Echinocandins

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35
Q

What infection characteristic would suggest the necessity for psueodmonas coverage?

A

Wound infection

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36
Q
  • What is B- lactamase?
A

Penicillin destroying enzyme

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37
Q

What is an example of B-lactam/B- lactamase inhibitor

A

Penicillin with clavulanic acid will inactivate B-lactamase (e.g Amoxicillin/Clavulanate (Clavulin)

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38
Q

What factors will lead you to suspect MRSA as a causative agent for skin infection?

A

Immunocompromised

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39
Q

Describe the three mechanisms pathogens use to block the immune system.

A

Destroying or block component of immune system,
Mimic self antigens
change antigenic profile

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40
Q

What is the deference in response to fever in children and adults?

A

Develop higher temperatures than adults do for relatively minor infections.
Febrile seizures before age 5 years are common.

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41
Q

How is older adults response to fever ?

A

Decreased or no fever response to infection; therefore, a decreased benefit of fever.
High morbidity and mortality result from lack of helpful aspects.

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42
Q
  • Whats the benefit of fever?
A

a. Rasing blody temperature kill MCOs and affects their growth and replication

b. Decrease serum level of iron, zinc and copper – mineral needed for bacterial replication

c. Cause lysosomal breakdown and auto destruction of cell, preventing replication in infected cells

d. Heat increases lymphocytic change and motility of polymorphonuclear neutrophils, helping the immune response

e. Enhanced phagocytosis and increased production of antiviral interferon

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43
Q

What is fever?

A

a. hypothalamic thermostat to a higher level in response to exogenous or endogenous pyrogens

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44
Q
  • what are the cytokines that promote fever?
A

a. cytokines (endogenous pyrogens- tumour necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6), and interferon (IFN).

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45
Q

What is the mechanism of fever?

A

Exogenous pyrogene- endotoxins from pathogens stimulate release of endogenous pyrogens from phagocytes- moocytes or macrophate
With screte cytokines
These rasie the body temperature by causing hypothalamus to create Prostaglandin E2 (PGE2)
PGE2 re-set thermostatic set point which stimulate autonomic nervous system
Causing shivering, muscule contraction, peripheral vasoconsticiton, increased metabolism mediated by thyroid hormone

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46
Q

What are risk factors for infection?

A

Age, pregnancy, immune compromise, malnutrition, poor sanitation, substandard living conditions, substance use

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47
Q

What infectious characteristic would suggest the necessity for peudomonas coverage?

A

Skin infection in persons with marlgiancies, HIV, diabetes burn, wound has deep abcess, cellulities, back or purple discoloration or eschar

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48
Q

What risk factors would lead you to suspect MRSA as a cuastive agent for skin infection?

A

Prolong hospitalization, recent antibiotic use, close contact with MRSA patient, immunocopromised individuals, drug use

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49
Q

What is B- lactamas? What is an example of B-lactam/B- lactamse inhibitor

A

B-lactam are penicillin destroying enzyme. Example of B- lactamse inhibitor amoxicillin/clavulanic acid e.g Cluvalin

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50
Q
  • What is acid fast bacilli? How is the process of identification of these bacteria different than the gram stating process.
A

Acid fast bacilli have high content of mycolic acid in their cell wall
Acid fast bacilli will be red while none acid fast bacteria will stain blue green when counter stained with kinyoun stain

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51
Q
  • When you send a specimen to the laboratory what tests do you order and what is done?
A

Order culture and sensitivity. (C&S)

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52
Q
  • What are the factors that influence antimicrobial therapy?
A

a. Site of infection- e.g meningitis- look for treatment that cross blood brain barrier. Blood brain cross determined by lipid soublabiity, molecular weight of drug and protein binding
b. Route of administration- oral or MI for mild infection- treated as out patient, IV for some initial treatment, some due to poor oral absorption – IV only- e.g vancomycin, amphotericin
c. Cost of therapy/coverage

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53
Q

What determine blood brain cross?

A

Lipid solubility, molecular weight of drug, protein binding

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54
Q

What does a gram stain look at?

A

Look at if the organism is G +ve or G -ve, shape- cocci or rod

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55
Q

What is minimum inhibitory concentration?

A

The lowest concentration of a drug that prevents visible growth of a microorganism after overnight incubation

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56
Q

What are the advantages of combining antibiotic?

A

Synergetic effect but

Additive nephrotoxicity/hepatotoxicity
May result in antagonistic effect

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57
Q

Which antibiotic has the most narrow spectrum of effect?

A

Penicillin or Methicillin or oxacillin

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58
Q

Which antibiotics has the broadest spectrum of effect? Why do you consider this when choosing antibiotic treatment of an infection

A

Antibiotic with broadest effect is Tigecycline. Why consider spectrum is you want to treat all possible causative agent if you did not do C & S and also to prevent resistance

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59
Q

Antibiotics that inhibit cell wall synthesis are

A

a. Cycloserine
b. Vancomycin
c. Bacitracin
d. Penicllins
e. Cephalosporine
f. Monobactams
g. Carbapenems

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60
Q

Protein synthesis- 50s inhibitors

A

a. Erythromycin (microlides
b. Chloramphenicols
c. Clindamycin
d. Lincomysin

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61
Q

Protein synthesis (30s inhibitors)

A

Tetracycline
Spectinomycin
Gentamicin
Kanamycin
Amikacin
Natrofurans

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62
Q
  • Antibiotics that inhibit folic acid metabolism?
A

Trimethroprim
Sulfonamides

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63
Q
  • DNA gyrase
A

Quinolones (nalidixic acid, ciprofloxacin, novoboicin)

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64
Q

Antibiotics that inhibit DNA directed RNA polymerase

A

a. Rifampin
b. Streptomyicins

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65
Q
  • RNA elongation
A

Actinomycin

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66
Q
  • Cytoplasmic membrane structure
A

Polymyxins and Daptomycin

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67
Q
  • B-lactam drug include what class of drug?
A

Penicillins.
Cephalosporins
Carbapenems and monobactams- usually IV, use for treatment of nosocomial infections

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68
Q
  • penicillin mechanism of action is what?
A

Bind to protein or stop synthesis of bacterial cell wall or lysis of bacteria cell wall

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69
Q
  • are penicillin bacteriostatic or bactericidal?
A

Bactericidal.

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70
Q
  • what is the route of elimination of penicillin
A

renal clearance so dose must be adjusted

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71
Q
  • what is the contraindication for penicillin?
A

Penicillin allergy

Theoretically interaction with oral contraceptives

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72
Q
  • what are the adverse effect of the class Penicillin
A

a. GI intolerance
b. Allergic rxn – IgE mediated hypersensitivity
c. Seizures
d. Interstitial nephritis
e. Rare blood dyscrasias

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73
Q
  • What are the drug interactions of class penicillin
A

Probeneic increases level
Good synergy with aminoglycosides

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74
Q
  • penicillin V (oral) G (IV) is used in treatment of what?
A

Sterptococcla infections (Strep throat, dental abscess, skin/soft tissue infections)
Group B infections (pregnant weomen, neonate)
Strep viridans (endocarditis)
S. penumiaea (often resistant)
Syphilis

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75
Q
  • Cloxacillin- b-lactamase resistance Penicillin is used in treatment of what?
A

Skin /soft tissue infection,
MRSA pneumonia
Endocarditis
It is eliminated by liver

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76
Q
  • Ampicillin/Amoxicillin has longer ½ life and broader spectrum, it is used for treating what?
A

Sinusitis,
Acute otitis media
UTI
Pyelonephritis
Preferred drug in pregnancy UTI irrespective of trimester.

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77
Q
  • Amoxicillin + clavulanic acid used in treatment of what?
A

Clavulanic acid effective against B-lactamse organism, drug choice where antibiotic resistance is high.
Treat- sinusitis, otitis media, UTI, Mixed infections (animal bite+ intra-abdominal infections)

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78
Q
  • Does penicillin cover pseudomonas?
A

No coverage for pseudomonas

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79
Q
  • Pharmacokinetics and dynamics of cephalosporins
A

1st -4th generation (better G -ve as generation progress and less G +ve coverage)
Short ½ life except Ceftraixone
Renal eliminated
Bacterocial and time depended killing

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80
Q

What generation of cephalosporin crosses CNS

A

3rd generation cephalosporin

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81
Q
  • Does cephalosporin cover MRSA, Enterococcus and listeria?
A

No

82
Q
  • What are Contraindications/ precautions for cephalosporins?
A

Strong association with C-diff, so monitor pt for diarrhoea and educate pt

83
Q

What are adverse effect of cephalosporins

A

GI intolerance
Allergic reaction- IgE mediated hypersensitivity
Seizure (high dose)
Interstitial nephritis
Rare blood dyscrasias

84
Q
  • Drug interactions for cephalosporin
A

Probenecid increases levels
Good synergy with aminoglycoside (Gentamycin)

85
Q
  • 1st generation cephalosporin is used for treatment of what?
A

Skin/soft tissues infection
Surgical prophylaxis
UTI
Exapmes Cephalexin, Cefadroxil
Cefazolin- good with MSSA, streptococci some enteric G -ve activity

86
Q
  • 2nd generation cephalosporin used in treating what?
A

Sinusitis
Otitis media
UTI
Community acquired pneumonia
Examples are Cefuroxime, cefaclor, Cefproxil Cefuroxime, cefoxitin

87
Q

3rd generation cephalosporin used in treating what?

A

For community acquired pneumonia
Meningitis: because if crosses CNS
Mixed infection
Gonorrhoea
Ceftazidine only covers pseudomonas
Examples Cefixime, Cefotaxime, ceftriaxone. ceftazidime

88
Q

4th and 5thd generation cephalosporin used in treating what?

A

Nosocomial infections

89
Q

True or false crossover reactivity with penicillin and other B- lactam including cephalosporin is less common than previously thought?

A

True

90
Q
  • True or false cross over activity with penicillin allergy is not the same for all generation of Cephalosporin?
A

True

91
Q
  • Relative risk of cross activity decreases as the generation increases in cephalosporin really occurring in 4th and 5th generation true or false?
A

True

92
Q
  • Which generation of Cephalosporin have the widest spectrum of activity?
A

4th generation.

93
Q
  • Class of antibiotics protein synthesis 50s inhibits how do they work?
A

They bind to the 50s subunits of the bacteria ribosomes, inhibiting translation in peptide bonds within growing bacteria cells. They are bacteriostatic

94
Q

What are the antibiotics in class of protein synthesis 50s inhibitor?

A

Macrolides-Erythromycin, Clarithromycin Azithromycin
Licosamide- clindamycin
Cholramphedenicol/Lincomycin

95
Q
  • Whats the pharmacokinethis/dynamics of macrolides
A

Bacteriostatic
Time dependent killing except Azithromycin
Increased ½ life
Biliary excretion- monitor liver function
Well absorbed orally

96
Q
  • Whats the precautions/contraindications of macrolides
A

QT elongation- if pt is on methadone which elongate QT- consider another agent
Renal monitoring

97
Q
  • What are the adverse effects of macrolides?
A

Liver function elevation- monitor LFT
GI/metallic taste
Diarrhoea
Ototoxicity
QT elongation

98
Q

Drug interaction of macrolides are?

A

P450 enzyme inhibitor- least with Azithromycin
Great alternative for penicllin allergic pt

99
Q
  • What are the common infections treated with macrolides?
A

Community acquire pneumonia (atypical coverage) + B-lactam
Acute exacerbation COPD
Acute otitis media
Sinusitis
Sexually transmitted chlamydia
GRED caused by H. pylori

100
Q
  • List of oragnisms treated with marcolides
A

Good- Atypical mycobacterium, H. influenzae, mycobacterium Avium.
Moderate: S. pneumonia, Strep pyogenes

101
Q
  • Clindamycin pharmacokinetic/dynamics (clindamycin is not a microlide)
A

Bacteriostatic
Time dependent killing
Good bioavailability PO and tissue penetration except CSF
Liver metabolism and entero-hepatic ciculariton
Not to be used lightly due to risk of resistance

102
Q
  • What are the contraindication/precaution of clindamycin?
A

QT prolongation
Renal adjustment required
C. difficile diarrhea (teaching and monitoring MUST be done

103
Q

What are the adverse effects of clindamycin?

A

++ GI intolerance (nausea, diarrhea, bitter taste)
Rash, hypersensitivity (rarely Stevens-Johnson syndrome)
Transient increase in LFTs (needs monitoring)

104
Q
  • Are clinidamycin a good alternative for penicllin allergic patient?
A

Yes

105
Q
  • Which orgaisms are clindamycin used for?
A

Enterococci Gram Positives
Anaerobes (oral and gut but increasing resistance)
Not great gram negative coverage (except anaerobes)
Anaerobic infections (Intra-abdominal, MRSA, DM foot)
Bacterial vaginosis
Acne
Oral dental abscesses (infections)

106
Q

Protein synthesis 30 S inhibitors include which classes of antibiotics?

A

Aminoglycosides
Tetracyclincs
Nitrifunration
Fosfomycin

107
Q

what is the pharmacokinetics/dynamics of aminoglyceoside?

A

Moderate to long half-life (q 8 hr. or q 24 hr.) Therefore, with IV infusion close monitoring, peaks/troughs that must be monitored by levels

108
Q

what are the contraindication/precautions?

A

Renal failure, pre-existing renal disease
Elderly patients
Previous hx of nephrotoxins
Prolonged treatment, greater than 3 days of treatment

109
Q

What are the adverse effects of aminoglyceosides?

A

Ototoxic (both IV and ++ caution with otic drops, must ensure tympanic membrane is intact or must choose another option (e.g. ciprofloxacin drops) NOTE: (Vestibular or cochlear damage) Irreversible unless caught early
Nephrotoxicity (monitor baseline and 2 x/w)

110
Q

Drug interactions of aminoglyceosides?

A

Other medications that are nephrotoxic

111
Q

what are the organisms treated with aminoglyceoside antibiotics?

A

Works best on gram negative and pseudomonas; however, Synergistic with other antimicrobials for gram positive infections: AMG + cell-wall active antimicrobial (penicillin, cephalosporin, carbapenem, vancomycin etc.), enterococcus, streptococci viridans, select S. aureus (clinical benefit uncertain), endocarditis Common example: Pyelonephritis IV Amp/Gent

112
Q

What are the names of aminoglycoside antibiotics?

A

Gentamicin
Tobramycin
Amikacin
Streptomycin
Neomycin (topical, optic/otic drops)

113
Q

What are the names of antibiotics in the class tetracycline

A

Tetracycline
Doxycline
Minocycline

114
Q

What are the pharmacokinetics/dynamics of tetracyclines?

A

Bacteriostatic (post-antibiotic effect like azithromycin)
Renal elimination (except Doxy)

115
Q

what are the contraindications/ precaution for tetracyclines?

A

Requires adjustment for renal dysfunction (tetracycline only)
Pregnancy and pediatrics- not safe in pregnancy and discolor teeth and bone health in children

116
Q

What are the drug interaction of the class tetracycline

A

Interact with divalent cations- e.g magnesium

117
Q

disease is tetracycline use to treat?

A

Gram positive, some gram negative, atypicals (e.g. Mycoplasma, Chlamydia, H. pylori, Rickettsiae) and Protozoa
Atypical Community Acquired Pneumonia (CAP)
STDs
Acne
Lyme,
GERD with H. pylori Malaria prophylaxis

118
Q

whats the pharmacodynamic/kinetics of nitrofurantoin?

A

requires good renal clearance to reach bladder in adequate dosing so not
recommended with eGFR < 50 ml/min.
CI in pregnant patients at term (38–42 weeks of gestation) due to the risk of hemolytic anemia.

119
Q

What are the adeverse effects of nitrofurantoin?

A

Peripheral neuropathy
Rare: serious pulmonary toxicity (acute pneumonitis, cough/fever/SOB) resolves with d/c drug Prolonged use can cause chronic pulmonary fibrosis

120
Q

what are the drug interactions of nitrofurantoin?

A

Antacids may decrease absorption

121
Q

What are the common orgainisim/ infection treated with Nitrofurantoin?

A

Mostly gram negative, some gram positive
Most frequently used with Urinary Tract Infection

122
Q

what is the mode of action of Fosfomycin?

A

Fosfomycin inhibits bacterial cell wall synthesis in different ways than Beta-lactams and glycopeptides, preventing the production of the building blocks of peptidoglycan

123
Q

what are the pharmacokinetics/dynamics of Fosfomycin?

A

Bactericidal but needs to be high concentration-dependent killing (only given single powder packet with ++ fluid)
Renal elimination (Requires adjustment for renal dysfunction

124
Q

what are the contrinidication/precautions of Fosfomycin?

A

Requires good renal clearance to reach bladder in adequate dosing so not recommended with eGFR < 50 ml/min.

125
Q

What are the adverse effect of Fosfomycin?

A

GI upset

126
Q

What are the common organism/infection treated with Fosfomycin

A

UTI/Cystitis E-coli (gram negative rods)
NOTE: Do Not use for renal/systemic infections such as pyelonephritis or urosepsis will lead to treatment failure.

127
Q

Whats the mode of action of the class of antibiotucs DNA topoisomerase?

A

They act on enzymes that participate in the overwinding or underwinding od DNA

128
Q

What are examples of DNA topoisomerase antibiotics

A

Fluroquinolones
Nitroimidazole

129
Q

what are the pharmacokinetics/dynamics of fluroquinolones?

A

Excellent PO bioavailability (>80%) and tissue penetration
Bactericidal, Concentration-dependent killing and Post-antibiotic effect
Long half-life
Renal or hepatic elimination (requires adjustment except Moxifloxacin)

130
Q

what are the contraindications/precautions of fluroquinolones?

A

Must warn about risk of Achilles tendinitis and Achilles tendon rupture

131
Q

What are the adverse effect of fluroqinolones?

A

GI intolerance – caution risk for C-diff post use
Photosensitivity and rare allergic reactions
Cartilage/chondrocyte toxicity (must warn about the risk of achilles tendinitis and Achilles tendon rupture)
Avoid in pregnancy

132
Q

what are the drug interaction of fluroquinolones?

A

Cipro – P450 inhibition e.g. warfarin (dose adjustment required)
Causes bonding btw divalent cations e.g. Ca, Fe, Mg

133
Q

What are the common organism/infection treated with fluroqinolone?

A

Some gram positive, broad gram negative, pseudomonas
*Moxifloxacin anaerobes (gut)
Urinary tract infections
Frequent/recurrent/complex, respiratory infections: sinusitis, CAP, Acute Exacerbation COPD (AECOPD)

134
Q

what are example of the class fluroquinolones?

A

Ciprofloxacin
Levofloxacin
Moxifloxacin
Norfloxacin
Ofloxacin (opth)
Gatifloxacin (opth)
Besifloxacin (opth

135
Q

. Example of the class Nitromidazole is what?

A

Metronidazole

136
Q

what are the pharmacokinetics/dynamics of Nitromidazole?

A

Mechanism: It is thought that Anaerobic bacteria and protozoa activate the drug molecule that forms free radicals resulting in DNA damage and cell death
Bactericidal, Concentration-dependent killing and Post-antibiotic effect
Extensively metabolized by the liver

137
Q

what are the contrinidication/precautions of nitromidazole?

A

Disturbs the GI flora and can result in Vancomycin-Resistant Enterococci (VRE), use with caution

138
Q

What are the adverse effect of nitromidazole?

A

GI upset/ metallic taste Hepatitis/Pancreatitis (rare)
Neuro: headaches, seizures and peripheral neuropathy (rare)

139
Q

what are the drug interaction of nitromidazole?

A

Alcohol Use – teaching must be done to avoid alcohol while using and 72 hr post completion - Causes disulfiram-like reactions because it inhibits aldehyde dehydrogenase
Interaction with warfarin – potentiates the anticoagulant properties (careful INR monitoring)

140
Q

What are the common organism/infection treated with nitromidazole?

A

Gram- Negative, Gram-Positive, anaerobes (including clostridium so works well for C diff infections)
NOTE: if C-diff relapses (may be resistant spore and other drugs should be considered
Protozoa (Trichomonas, Entamoeba and Giardia)
H. Pylori

141
Q

What are examples of antibiotics class that disrupt folic acid metabolism?

A

Sulfonamides – examples sulfamthozazole/trimethoprim also known as Cotrimoxacole (septra)

142
Q

what are the pharmacokinetics/dynamics of sulfonamides?

A

Bacteriostatic – each component;
Bactericidal – when combined Wide tissue distribution incl. CSF
Renal elimination (dose adjustment required)

143
Q

what are the contraindications/precautions of sulfonamides?

A

Use with caution in renal failure Seniors
CI in infants because of the risk of kernicterus

144
Q

What are the adverse effect of sulfonamides

A

Hyperkalemia
Hypoglycemia
Hypersensitivity reactions
Cystalluria
Bone marrow suppression
Hepatotoxicity
Hemolytic anemia (esp. in G6PD deficiency)

145
Q

what are the drug interaction of sulfonamides?

A

P450 interaction and protein binding interaction e.g. warfarin

146
Q

What are the common organism/infection treated with sulfonamides?

A

MRSA, gram negative and gram positive coverage (see chart)
pneumocystis pneumonia (PCP) both treatment/prevention
Urinary Tract Infections,
Prostatitis (non-STI pathogens
Skin and soft tissue infections (especially with concern of MRSA)
GI infections (e.g. Traveler’s diarrhea, shigellosis)

147
Q

What is the difference between bactericidal and bacteriostatic? *

A

Bacteriostatic- kill bacteria by inhibiting futher growth/or inhibit multiplication of bacteria without killing it
Bactericidal- kills the bacteria

148
Q

What do Fosfomycin and Penicillin have in common? What about Fosfomycin and Vancomycin?

A

Fosfomycin and pencillin commonalities- both act on cell wall
Vacomycin and Fosfomycin- act on cell wall but fosomycin is not a B-lactam drug

149
Q

With respect to the impacts of Septra on folic acid synthesis, which life stages would this drug be contraindicated

A

Pediatric <2months due to risk of megaloblast anemia or kernicterus (brain damage)

150
Q

what is Diflucan and what is it used for?

A

Diflucan (fluconazole) is and antifungi, used in treatment of fungi infection

151
Q

fungi are made up of different group

A

Yeast
Mold
Diamorphic fungi.

152
Q

What are examples of yeast?

A

Candida
Cryptococcus
Dermatophyte

153
Q

What are examples of molds

A

Aspergillus
Fusarium
Scedosporium
Mucorales

154
Q

What are examples of diamorphic fungi

A

Histoplasma
Blastomyces
Coccidioides (Valley fever)

155
Q

What are the classes of antifungi

A

Azoles
Polyene
Others

156
Q

What are the drugs in the class Azoles?

A

Clotrimazole
Ketoconazole
Fluconazole
Miconiazole
Terconazole
efinacoazole

157
Q

what are the pharmacokinetics/dynamics of Azole?

A

Mechanism of action: inhibiting fungal cytochrome P450, decreasing ergosterol production.

158
Q

what are the contraindications/precautions of azole?

A

QT prolongation (orals) Itraconazole is contraindicated in patients with Heart Failure (due to it being a negative inotrope)

159
Q

What are the adverse effect of Azole

A

Topical: well tolerated but erythema and topical irritation can occur
Oral: hepatotoxicity, rash, diarrhea (Itraconazole)
Rare: headaches, visual disturbances, renal failure, Stevens-Johnson Syndrome

160
Q

what are the drug interaction of Azole

A

PLEASE DOUBLE CHECK DRUG INTERACTIONS WITH ALL AZOLES (associated with mechanism of action: P450 activity)
Major interactions with drugs metabolized via:
CYP 3A4(e.g: Phenytoin, Carbamazepine)
CYP2C9(e.g: Warfarin

161
Q

What are the common organism/infection treated with Azole?

A

Mostly skin/mucosal infections
Yeast (Candida) infections
Dermatophyte (Tinea)
Itraconazole the drug of choice for histoplasmosis/blastomycosis/aspergillus

162
Q

what are the pharmacokinetics/dynamics of terbinafine (Lamisil)

A

Topical/oral
Fungicidal
Less toxic and fewer interactions than systemic azoles

163
Q

what are the drug interaction of terbinafine (lamisil)

A

2D6 inhibitor – various interactions

164
Q

What are the adverse effect of terbinafine (Lamisil)

A

GI intolerance
Headache, rash
Sensory disturbance (smell, taste, hearing)
Hepatotoxicity

165
Q

What are the common organism/infection treated with terninafine

A

Onychomycosis (nail infections – oral preparations only work) severe tinea infections

166
Q

Onychomycosis is fungi of what area? How is it treated

A

Fungi of nail must be treated systemically, because topic cream not effective

167
Q

What is the anatomical site of Tinea corporis? And whats the treatment

A

Body , treatment topical azole cream – e,g clotrimazole, miconazole, Lamisil, - oral antifungal Fluconazole

168
Q

What is the anatomical site of Tinea faciei

A

Face-

169
Q

What is the anatomical site of Tinea capitis?

A

Head (on the hair)

170
Q

What is the anatomical site of Tinea versicolor coporis?

A

Skin on back

171
Q

What is the anatomical site of Tinea cruris (jock itch- ?

A

Groin

172
Q

What are the pharmacokinetic/dynamics of nystatin

A

Topical/oral/suspension for mucosa
Funigstatic and fungicidal
Less effective for most conditions but safe
Little systemic absorption

173
Q

what is nystatin use to treat

A

Mostly oropharyngeal/mucosal infections (thrush) Yeast (Candida) infections (only)

174
Q

What are common yeast infection in Canada?

A

Newborns-who breastfeed (mouth and diaper rash)
Women when breast feeling get mastitis, the vaginal tract with proteintial to transefer to sexual patterns
Can occur in immunocompromised- HIV and diabetes
Treatment azole creams
Breast – may need oral azole

175
Q

infants oral thrush is treated with what?

A

Oral mycostatin (Nystatin

176
Q

What is the warning regarding Gentian violet

A

It has very serious risk- May increase risk of cancer

177
Q

what is antigenic variation is a means by which viruse elude human immue system so what is antigenic variation?

A

Changing viral surface antigen- a process known as antigenic variation

178
Q

what is antigenic variation?

A

Mechanism by which an infectious organism alters the proteins or carbohydrates on its surface in other to avoid host immunity.

179
Q

what is antigenic drift.

A

Minor antigenic variation

180
Q

what is antigenic shift

A

Major antigenic variation

181
Q

what is the function of HA (hemagglutin) and NA (neuramindase)

A

HA (hemagglutin- help bind to respiratory cells to allow infection
NA (neuraminidase) release new viron and help with spread of infection

182
Q

can antigenic shift occur in influenza a where an human subtime and avian subtime co infect a specie to crease a new HA or NA antigen – True or false

A

true

183
Q

What is the treatment for flu?

A

Flu is usually self limiting
Can be treated with Oseltamivir (Tamiflu) – adjust with renal function.
Zanamivir (Relenza) – don’t use in those with asthma & COPD- risk of bronchospasm & wheeze

184
Q

what is viral reactivation.

A

Process by which a latent virus switches to the lytic phase of replication

185
Q

what are the most common viruses in the DNA virus family Herpes?

A

Herpes simplex virus, varicella zoster virus, Epstein Barr Virus, cytomegalovirus

186
Q

What are the treatment of the family human herpes virus?

A

Topical Acyclovir, Docosanol
Systemic: Acyclovir (PO/IV)

187
Q
A
188
Q

What is the treatment of chickenpox in children?

A

No treatment, prevent with vaccination at 15months

189
Q

What is the treatment of chickenpox in adult

A

Treat with antiviral within 24hrs of onset of rash
1st line Famciclovir or Valacyclovir

190
Q

what is the treatment of chickenpox in pregnancy/neonate

A

1st line -Acyclovir IV or PO, prevention VariZIG

191
Q

what is used to prevent reactivation of varicella zoster?

A

Vaccination with shingle vaccine at 50yrs
Treatment with 1st line Famciclovir or Valacyclovir with gabapentin for neurologic pain

192
Q

Dermatone near eye what will be your action?

A

Emergency- refer to ophthalmology (retinal involvement)

193
Q

What population should be treated with antiviral for chicken pox

A

Adult should be treated with antiviral within 24hrs of onset of rash

194
Q

What are the benefits in treating varicella zoster (shingles)

A

Prevent reactivation of disease, decrease duration of disaease and neuropathy

195
Q

when should suppressive therapy for HSV be considered in pregnancy to prevent vertical transmission

A
196
Q

A patient with a penicillin allergy can safely be given which class of medication of beta lactam antibiotics, with no risk of cross activity

A

Aztreonam (Monobactam Class)

197
Q

Patient been treated with MRSA with IV antibiotics, begins to develop a red rash across his head neck throat and extremities has the IV anabiotic is being administered. Which anabiotic is this patient likely receiving.

A

Vancomycin

198
Q

which is the only medication of the Carbapenem in class that is not cover pseudomonas so that is going to beat her to

A

Ertapenem

199
Q

Which medication is the first line for chlamydia, rocky mountain spotted fever, and Lyme disease

A

Doxycycline

200
Q

Which fifth generation cephalosporin has coverage against MRSA

A

Ceftaroline

Nur 1142 Patho (15 decks)

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