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MTB STEP 3 > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Sensitive staph (MSSA): IV and ORAL Tx

A

IV: oxacillin/nafcillin or cefazolin (first gen cephalosporin)

Oral: dicloxacillin or cephalexin ( first gen cephalosporin)

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2
Q

What microbe most commonly affects Bone, heart, skin and joints.

A

Staph Aureus

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3
Q

Resistant staph (MRSA): Severe infection treatments?

A

Severe infection: Vancomycin, linezolid, daptomycin, ceftaroline, tigecycline, or telavancin.
Linezolid causes thrombocytopenia.
Daptomycin causes myopathy and a rising CPK.

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4
Q

Resistant staph (MRSA): Minor nfection treatments?

A

Minor infection: Trimethoprim/sulfamethoxazole (TMP/SMX), clindamycin, doxycycline

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5
Q

Tx of Staph Aureus in a pt with Penicillin allergy?

A

– Rash: Safe to use cephalosporins
– Anaphylaxis: Macrolides (azithromycin, clarithromycin) or clindamycin
– Severe infection: Vancomycin, linezolid, daptomycin, telavancin
– Minor infection: Macrolides (azithromycin, clarithromycin), clindamycin,
TMP/SMX

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6
Q

Fact! Telavancin is a vancomycin derivative with similar

efficacy.

A

.

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7
Q

Fact! If the organism is sensitive, oxacillin and nafcillin are superior to vancomycin.

A

.

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8
Q

How to treat Strepococcus?

A 
Use the same drugs as Staph.
Medications that are specific for Streptococcus:
·· Penicillin
·· Ampicillin
·· Amoxicillin
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9
Q

Gram-negative bacilli (rods)?

A 
Escherichia coli,
Enterobacter,
Citrobacter, 
Morganella, 
Pseudomonas, 
Serratia
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10
Q

Treatment for Gram-negative bacilli (rods):

A

All of the following medications are essentially equal in their efficacy for gram negative bacilli.

1) Cephalosporine
2) Penicillins
3) Monobactam: Aztreoman
4) Quinolones
5) Aminoglycosides
6) Carbapenems

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11
Q

Cephalosporine examples?

A

Cefepime

Ceftazidime

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12
Q

Penicillins examples?

A

Piperacillin

Ticarcillin

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13
Q

Quinolones examples?

A

Ciprofloxacin
Levofloxacin
Moxifloxacin
Gemifloxacin

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14
Q

Aminoglycosides examples?

A

Gentamicin
Tobramycin
Amikacin

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15
Q

Carbapenems examples?

A

Imipenem
Meropenem
Ertapenem
Doripenem

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16
Q

Mechanism of Beta-lactam Abx

A

The 4 beta-lactam antibiotics all inhibit the cell wall by binding the penicillin-binding protein. The 4 classes are:
•• Penicillin
•• Cephalosporins
•• Carbapenem
•• Monobactam (the only one is aztreonam)

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17
Q

Treatment of Gastrointestinal anaerobes (Bacteroides)

A
    • Metronidazole is the best medication for abdominal anaerobes.
    • Carbapenems, piperacillin, and ticarcillin are equal in efficacy for abdominal anaerobes compared to metronidazole.
    • Cefoxitin and cefotetan (in the cephamycin class) are the only cephalosporins that cover anaerobes.
18
Q

Treatment of Respiratory anaerobes (anaerobic strep)

A

Clindamycin is the best drug for anaerobic strep

19
Q

Medications with no anaerobic coverage

A

Aminoglycosides, aztreonam, fluoroquinolones, oxacillin/nafcillin, and all the cephalosporins except cefoxitin and cefotetan

20
Q

Tx of herpes simplex, varicella zoster.

A

Acyclovir, valacyclovir, and famciclovir: All 3 of these agents are equal in efficacy

21
Q

Tx of cytomegalovirus [CMV]

A

Valganciclovir, ganciclovir, and foscarnet
These are essentially equal in efficacy. They also cover herpes simplex and varicella. Valganciclovir is the best long-term therapy for CMV retinitis.

22
Q

Adverse effect of Valganciclovir and ganciclovir:

A

Neutropenia and bone marrow suppression

23
Q

Adverse effect of Foscarnet

A

Renal toxicity

24
Q

oral agents used to tx chronic hepatitis C

A

Telaprevir, boceprevir, simeprevir, sofosbuvir: None is used as a single agent. Sofosbuvir does not need to be combined with interferon.

25
Q

Influenza A and B tx

A

Oseltamivir and zanamivir (neuraminidase inhibitors):

26
Q

Hepatitis C (in combination with interferon), respiratory syncytial virus (RSV) treatment

A

Ribavirin

Ribavirin causes anemia

27
Q

Chronic hepatitis B tx

A

Lamivudine, interferon, adefovir, tenofovir, entecavir, and telbivudine

28
Q

Mechanisms of Oral Hepatitis C Medications.

1)Sofosbuvir. 2) Simeprevir, boceprevir, and telaprevir

A
  • Sofosbuvir: RNA polymerase inhibitor
  • Simeprevir, boceprevir, and telaprevir: Protease inhibitors that prevent viral maturation by inhibiting protein synthesis
29
Q

Fluconazole treats

A

Candida (not Candida krusei or Candida glabrata), Cryptococcus, oral and vaginal candidiasis as an alternative to topical mediations

30
Q

Itraconazole treats

A

Largely equal to fluconazole but less easy to use; rarely the best initial therapy for anything

31
Q

Voriconazole treats

A

Covers all Candida; best agent against Aspergillus. Adverse effect:
– Some visual disturbance

32
Q

Posaconazole treats

A

Also covers mucormycosis or Mucorales

33
Q

Echinocandins (caspofungin, micafungin, anidulafungin) treats

A
    • Excellent for neutropenic fever patients.
    • Does not cover Cryptococcus.
    • Better than amphotericin for neutropenia and fever (less mortality).
    • Adverse effect—Echinocandins have no significant human toxicity because they affect/inhibit the 1,3 glucan synthesis step, which does not exist in humans.
34
Q

Mechanism of Antifungal Medications

A

Azole antifungals inhibit conversion of lanosterol to ergosterol. Ergosterol is the major component of the cell wall of fungi. Disrupting ergosterol damages the cell membrane and increases its permeability, resulting in cell
lysis and death.

35
Q

Amphotericin treats

A

Effective against all Candida, Cryptococcus, and Aspergillus:
– The last 2 main indications for amphotericin are Cryptococcus and mucormycosis.

36
Q

Best meds to treat Aspergillus

A

Voriconazole superior to amphotericin

37
Q

Best to treat neutropenic fever

A

Caspofungin superior to amphotericin

38
Q

Fact! Fluconazole vs amphotericin in the tx of candida

A

Fluconazole is equal to amphotericin to treat candida but has far fewer adverse effects.

39
Q

Adverse effects of amphotericin

A

renal toxicity (increased creatinine); hypokalemia; metabolic acidosis; fever, shakes, chills

40
Q

Mechanism of Renal Toxicity of Amphotericin

A

Amphotericin is directly toxic to the tubules. Distal tubule toxicity results in renal tubular acidosis. Distal RTA gives excess potassium and magnesium loss and hydrogen ion retention. When renal toxicity is described, the answer is
“Switch to liposomal amphotericin.”

MTB STEP 3 (2 decks)

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