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NAPLEX > Infectious Disease > Flashcards

Infectious Disease Flashcards

1
Q

Which organism has a thick cell wall, stain dark purple or bluish from the crystal violet stain

A

Gram +

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2
Q

Which organism have a thin cell wall and take up the safranin counterstain, resulting in a pink or reddish color

A

Gram -

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3
Q

Which organisms do not have a cell wall and do not stain well

A

Atypical

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4
Q

Intrinsic resistance

A

the resistance is natural to the organism. For example, E. Coli is resistant to vancomycin b/c this abx is too large to penetrate the bacterial cell wall of E. coli

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5
Q

Selection pressure

A

resistance occurs when abx kill off susceptible bacteria, leaving behind more resistant strains to multiply. For example, normal GI flora includes Enterococcus. When abx (vancomycin) eliminate susceptible Enterococci, vancomycin-resistant enterococcus (VRE) can become predominant

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6
Q

Enzyme inactivation

A

enzymes produced by bacteria break down the antibiotic

ex. beta-lactamase

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7
Q

List beta-lactamase inhibitors (5)

A

clavulanate
sulvactam
tazobactam
avibactam

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8
Q

ESBLs

  • breakdown?
  • treatment (2)
A

break down all PCN and most cephalosporins

treatment: Carbapenems, newer cephalosporin/beta-lactamase inhibitors

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9
Q

CRE

  • breakdown?
  • treatment (2)
A

MDR Gram- organisms (Klebsiella spp., E. coli) that produce enzymes (e.g carbapenemase) capable to breaking down penicillins, most cephalosporins, and carbapenems.
Treatment: polymyxins, ceftazidime/avibactam (avycaz)

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10
Q

common resistant pathogens

A 
Kill Each And Every Strong Pathogen
Klebsiella pneumonia (ESBL, CRE)
E. Coli (ESBL, CRE)
Acinetobacter baumannii
Entercoccus faecalis/faecium (VRE)
Staphlococcus aureus (MRSA)
Pseudomonas aeruginosa
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11
Q

Folic acid synthesis inhibitors (3)

A

Sulfonamides
trimethoprim
dapsone

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12
Q

Cell wall inhibitors (3 classes)

A

beta-lactams (pcns, cephalosporins, carbapenems)
monobactams (aztreonams)
vancomycin, dalbavancin, telavancin, oritavancin

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13
Q

protein synthesis inhibitors (6)

A 
aminoglycosides
macrolides
tetracyclines
clindamycin
linezolid, tedizolid
quinupristin/dalfopristin
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14
Q

Cell membrane inhibitors (4)

A

polymyxins
daptomycin
telavancin
oritavancin

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15
Q

DNA/RNA inhibitors (3)

A

Quinolones (DNA gyrase, topoisomerase IV)
Metonidazole, tinidazole
Rifampin

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16
Q

concentration-dependent killing (3)

A

aminoglycosides
quinolones
daptomycin

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17
Q

AUC:MIC killing (4)

A

Vancomycin
macrolides
tetracyclines
polymyxins

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18
Q

time-dependent killing (1)

A

beta-lactams (pcns, chephalosporins, carbapenems)

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19
Q

MOA of beta-lactam antibiotics

A

they have a beta-lactam ring and inhibit bacterial cell wall synthesis by binding to penicillin-binding proteins (PBPs). prevents the final step of peptidoglycan synthesis in bacterial cell walls

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20
Q

Natural penicillins coverage (2)

A

Gram + cocci
-Streptococci, Enterococci, NOT staphylocci
Gram + anaerobes (mouth flora)

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21
Q

Aminopenicillins coverage

A

all the same as natural pcns
+
Gram - (HNPEK)
Haemophilus, Neisseria, Proteus, E. coli, Klebsiella

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22
Q

Aminopenicillins + beta-lactamase coverage

A

added activity to MSSA
more resistant strains of gram - (HNPEK)
Gram - anaerobes (B. fragilis)

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23
Q

Extended-spectrum PCN coverage

A 
broad coverage
all same coverage as aminopcn 
\+
Gram - bacteria
-Citrobacter, Acinetobacter, Providenia, Enterobcter, Serratia (CAPES) and pseudomonas
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24
Q

Antistaphylococcal PCN coverage

A

streptococci
enhanced activity to MSSA
lack activity to Enterococcus, Gram -, and anaerobes

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25
Q

Natural PCN (1)

A

Penicillin

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26
Q

Aminopenicillins (2)

A

Amoxicillin

Ampicillin

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27
Q

Aminopenicillins + beta-lactamase (2)

A

Augmentin
-amoxicillin/clavulanate
Unasyn
-ampicillin/sulbactam

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28
Q

Extended spectrum PCN (1)

A

zosyn

-piperacillin/tazobactam

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29
Q

Antistaphylococcal PCN (3)

A

Dicloxacillin
Nafcillin
Oxacillin

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30
Q

What class of abx increases risk of seizures if accumulation occurs (with renal failure)

A

Penicillins

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31
Q

first-line treatment for strep throat and mild nonpurulent skin infections

A

Penicillin VK

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32
Q

First-line treatment for acute otitis media

A

amoxicillin

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33
Q

DOC for IE prophylaxis before dental procedures

A

Amoxicllin

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34
Q

First-line for acute otitis media and for sinus infections

A

Augmentin

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35
Q

DOC for syphilis

A

Penicillin G Benzathine

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36
Q

Which PCN is not for IV because can cause death

A

Penicillin G Benzathine

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37
Q

Only PCN active against Pseudomonas

A

Zosyn

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38
Q

Which PCN cover MSSA only no MRSA

A

Nafcillin, Oxacillin, Dicloxacillin

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39
Q

Which PCN have no renal dosage adjustments

A

Nafcillin, oxacillin, dicloxacillin

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40
Q

Cephalosporins as a class are not active against (2)

A

Enterococcus or atypical

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41
Q

1st Generation cephalosporins coverage (3)

A

Gram + (stretococci and staphylocci)
MSSA
Gram - Rods (Proteus, E. coli, Klebsiella) (PEK)

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42
Q

Which generation has the least Gram - coverage

A

1st generation

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43
Q

2nd generation cephalosporin coverage

A

2 types

  • Cefuroxime: staphylocci, HNPEK
  • Cefotetan, Cefoxitin: also Gram - anaerobes (B. fragilis)
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44
Q

3rd generation cephalosporin coverage

A 
2 groups
a) ceftriaxone, cefotaxine, and oral drugs
   -more resistant Strep (s. pneumo, viridans)
   - MSSA    
   - Gram +  anaerobes (mouth flora)
   - more resistant HNPEK
b) ceftazidime
   - lack Gram + coverage
   - Pseudomonas
    ceftazidime/avibactam, ceftolozane/tazobactam
   - also MDR pseudomonas
   - also NDR Gram - Rods
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45
Q

4th generation cephalosporin coverage

A

broad Gram - activity (HNPEK, CAPES, pseudomonas)

Gram + coverage similar to ceftriaxone

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46
Q

5th generation cephalosporin coverage

A

Gram - activity similar to ceftriaxone
broad gram + activity
only beta-lactam to cover MRSA

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47
Q

1st generation cephalosporins (3)

A

cefazolin
cefhalexin
cefadroxil

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48
Q

2nd generation cephalosporins (5)

A 
cefuroxime
cefotetan
cefaclor
cefoxitin
cefprozil
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49
Q

3rd generation cephalosporins group 1 (7)

A 
cefdinir
ceftriaxone
cefotaxime
cefditoren
cefixime
cefpodoxime
ceftibuten
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50
Q

3rd generation cephalosporins group 2 (3)

A

ceftazidime
ceftazidime/avibactam
ceftolozane/tazobactam

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51
Q

4th generation cephalosporins (1)

A

cefepime

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52
Q

5th generation cephalosporins (1)

A

ceftaroline

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53
Q

cephalosporins have a cross-reactivity with what allergy

A

PCN

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54
Q

common use of cephalexin (2)

A

skin infection: MSSA

strep throat

55
Q

common use of cefuroxime (3)

A

acute otitis media
CAP
sinus infection

56
Q

common use of cefdinir (2)

A

CAP

sinus infection

57
Q

common use of cefazolin

A

surgical prophylaxis

58
Q

cefotetan and cefoxitin have what abnormal coverage

A

B. fragilis (anaerobic coverage)

59
Q

common use for cefotetan and cefoxitin

A

surgical prophylaxis (colorectal)

60
Q

what cephalosporin can have a disulfiram-like reaction with alcohol

A

cefotetan

61
Q

common use of ceftriaxone and cefotaxime (4)

A

CAP
meningitis
SBP
pyelonephritis

62
Q

Does ceftriaxone have renal dose adjustment

A

No

63
Q

what is the only beta-lactam active against MRSA

A

ceftaroline

64
Q 
Carbapenem coverage (2)
No coverage (5)
A

most Gram + & Gram -
anaerobic pathogens
NO atypical, MRSA, VRE, C. diff, stenotrophomonas

65
Q

Ertapenem has no activity to? (3)

A

Pseudomonas
Acinetobacter
Enterococcus

66
Q

carbapenem caution in which population

A

dec. seizure control

67
Q

All carbapenems cover what two organisms

A

ESBLs

pseudomonas-except ertapenem

68
Q

All carbapenems do not cover (5)

A 
atypicals
VRE
MRSA
C. diff
stenotrophomonas
69
Q

Name monobactams (1)

A

aztreonam

70
Q

MOA of aztreonam

A

inhibits bacgerial cell wall synthesis by binding to penicillin binding proteins which prevents teh inal step of peptiodglycan synthesis in bacterial cell walls. The monobactam structure makes cross-reactivity with a beta-lactamallergy unlikely

71
Q

Aztreonam activity

A

many Gram -
Pseudomonas
No Gram +

72
Q

Aminoglycoside MOA

A

bind to the ribosome which intereferes with bacterial protein synthesis and results in a defective bacterial cell membrane

73
Q

Aminoglycoside coverage

A

Gram - , pseudomonas

74
Q

traditional dosing for aminoglycosides

A

lower doses more frequently

75
Q

Extende interval dosing for aminoglycosides

A

higher doses to attain higher peaks less frequently this decreases nephrotoxcity

76
Q

toxicity of aminoglycosides (2)

A

nephrotoxicity

ototoxicity

77
Q

list carbapenems (4)

A

doripenem
imipenem/cilastin
meropenem
ertapenem

78
Q

Aminoglycoside dose adjustment on body weight

A

underweight: use total body weight
obese: use addjusted body weight

79
Q

Quinolone MOA

A

inhibit bacterial DNA topoisomerase IV and DNA gyrase (topoisomerase II) inside the bacteria. this prevents supercoiling of DNA and promotes breakage of double-stranded DNA

80
Q 
Respiratory quinolones (3)
why are they called this?
A

gemifloxacin
levofloxacin
moxifloxacin
-b/c enhanced coverage of S. pneumonia and atypical coverage

81
Q

which quinolones cover pseudomonas

A

ciprofloxacin

levofloxacin

82
Q

Which quinolone cannot treat UTIs

A

Moxifloxacin

83
Q

Which quinolone has acitivity against MRSA

A

Delafloxacin

84
Q

Quinolones and warfarin

A

inc. warfarin concentration

85
Q

Quinolones and hypoglycemic drugs

A

inc. effects of hypoglycemic drugs

86
Q

Antipseudomonal Quinolones (2)

A

ciprofloxacin

levofloxacin

87
Q

Macrolides MOA

A

bind to the 50s ribosomal subunit resulting in inhibition of RNA-dependent protein synthesis

88
Q

Macrolides coverage

A 
atypicals
-legionella
-chlamydia
-mycoplasma
-mycobacterium avium complex
Haemophilus
89
Q

Macrolides are common treatment for (2)

A

CAP

STIs (chlamydia, gonnorrhea)

90
Q

List macrolides (3)

A

azithromycin
clarithromycin
erythromycin

91
Q

tetracycline MOA

A

inhibit bacterial protein synthesis by reversibly binding to the 30s ribosomal subunit

92
Q

Tetracyclines coverage

A

Gram + (staph, trep, enterococci, nocardia, bacillus, propionibacterum)
Gram - including respiratory flroa (Haemophilus, Moraxella, atypicals)
spriochetes
rickettsiae
Bacillus anthracis
treponema

93
Q

Doxycycline indications

A 
RTI (CAP)
tick/rickettsial disease
STI
MRSA skin infection 
VRE UTI
94
Q

Minocycline indications

A

skin infections including acne

95
Q

What is one major caution in using a tetracycline

A

do not use in those <8 years can suppresses bone growth and skeletal development and permanently discolors teeth

96
Q

Sulfonamides MOA

A

inhibit dihydrofolic acid formation from para-aminobenzoic acid, which interferes with bacterial folic acid synthesis

97
Q

Trimethoprim MOA

A

inhibits dihydrofolic acid reduction to tetrahydrofolate, resultin gin inhibition of the folic acid pathway

98
Q

Bactrim coverage

A 
staphlyococci (MRSA, CA-MRSA)
S. pneumoniae
Gram - (broad)
Shiqella
Salmonella
Stenotrophomonas
opportunisitc pathogens (nocardia, pneumonocytis, toxoplasmosis)
NO coverage: psedumonas, enterococci, anaerobes
99
Q

Bactrim & Warfarin

A

INR increased when used with warfarin

100
Q

glycopeptide MOA

A

inhibit bacterial cell wall synthesis by binding to the D-alanyl-D-alanine cell wall precursor and blocking peptidoglycan polymerization

101
Q

Vancomycin coverage

A

Gram + only

-MRSA, streptococci, enterococci (not VRE), C. difficile

102
Q

lipoglycopeptides MOA

A

inhibit bacterial cell wall synthesis by binding to D-alanyl-D-alanine portion of cell wall, blocking plymerization and cross-linking of peptidoglycan and disrupting bacterial membrane potential and changing cell permeability

103
Q

List lipoglycopeptides (3)

A

telavancin
oritavancin
dalbavancin

104
Q

Daptomycin coverage

A

Gram + (MRSA, enterococci [VRE])

105
Q

Which condition can daptomycin not be used

A

pneumonia b/c due is inactivated by lung surfactant

106
Q

Oxazolidinones MOA

A

bind to the 50s subunit of te bacterial ribosome, inhibiting translation and protein synthesis

107
Q

Oxazolidinones list (2)

A

linezolid

tedizolid

108
Q

Oxazolidinones coverage

A

Gram + and VRE

109
Q

Quinupristin/dalfopristin MOA

A

bind to the 50s ribosomal subnit inhibiting protein synthesis

110
Q

Quinupristin/dalfopristin coverage

A

Gram + (MRSA, VRE not E. faecalis)

111
Q

Tigecycline MOA

A

binds to the 30s ribosomal subnit inhibitin gprotein synthesis, structurally related to the tetracycliens

112
Q

Tigecycline coverage

A

Gram + (MRSA, VRE)
Gram - (no activity against the 3Ps: pseudomonas, proteus, providenica)
anaerobes
atypical

113
Q

Tigecycline indication (3)

A

SSTi
IAI
CAP

114
Q

list polymyxins (2)

A

colistin

polymyxin B

115
Q

polymyxin coverage

A

Gram -

116
Q

Chloramphenicol MOA

A

binds to 50s subunit jof bacterial ribosome inhibiting protein synthesis

117
Q

Chloramphenicol coverage

A

Gram + & Gram -
anaerobes
aytpical

118
Q

Clindamycin MOA

A

reversibly binds to the 50s subunit of the bacterial ribosome inhibiting proetin synthesis

119
Q

Clindamycin coverage

A

anaerobes
Gram +
NOT cover: Enterococcus, Gram -

120
Q

Metronidazole MOA

A

cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis

121
Q

Metronidazole coverage

A

anaerobes

protozoal infections

122
Q

Fidaxomicin MOA

A

inhibits RNA polymerase, resulting in inhibition of proetin synthesis and cell death

123
Q

Fidaxomicin indication

A

C. diff

124
Q

Rifaximin MOA

A

inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase

125
Q

Rifaximin coverage

A

E. Coli

126
Q

Fosfomycin MOA

A

inhibits bacterial cell wall synthesis by inactivating the enzyme pyruval transferase which is critical in the synthesis of cell walls

127
Q

Fosfomycin Indication

A

UTI

128
Q

Fosfomycin coverage

A

E. coli (ESBL)

E. Faecalis (VRE)

129
Q

Nitrofurantoin MOA

A

bacterial cell wall inhibitor

130
Q

Nitrofurantoin indication

A

uncomplicated UTI

131
Q

Nitrofurantoin coverage

A 
E. coli
klebsiella
Enterobacter
S. aureus
Enterococcus (VRE)
132
Q

Nitrofurantoin Contraindication

A

CrCl < 60

133
Q

Mupirocin ointment indication

A

eliminate staphylcocci MRSA colonization of the nares

134
Q

Do lipophilic or hydrophilic antimicrobials have better tissue penetration

A

lipophilic

NAPLEX (65 decks)

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