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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
Natural PCN (1)
Penicillin
26
Aminopenicillins (2)
Amoxicillin | Ampicillin
27
Aminopenicillins + beta-lactamase (2)
Augmentin -amoxicillin/clavulanate Unasyn -ampicillin/sulbactam
28
Extended spectrum PCN (1)
zosyn | -piperacillin/tazobactam
29
Antistaphylococcal PCN (3)
Dicloxacillin Nafcillin Oxacillin
30
What class of abx increases risk of seizures if accumulation occurs (with renal failure)
Penicillins
31
first-line treatment for strep throat and mild nonpurulent skin infections
Penicillin VK
32
First-line treatment for acute otitis media
amoxicillin
33
DOC for IE prophylaxis before dental procedures
Amoxicllin
34
First-line for acute otitis media and for sinus infections
Augmentin
35
DOC for syphilis
Penicillin G Benzathine
36
Which PCN is not for IV because can cause death
Penicillin G Benzathine
37
Only PCN active against Pseudomonas
Zosyn
38
Which PCN cover MSSA only no MRSA
Nafcillin, Oxacillin, Dicloxacillin
39
Which PCN have no renal dosage adjustments
Nafcillin, oxacillin, dicloxacillin
40
Cephalosporins as a class are not active against (2)
Enterococcus or atypical
41
1st Generation cephalosporins coverage (3)
Gram + (stretococci and staphylocci) MSSA Gram - Rods (Proteus, E. coli, Klebsiella) (PEK)
42
Which generation has the least Gram - coverage
1st generation
43
2nd generation cephalosporin coverage
2 types - Cefuroxime: staphylocci, HNPEK - Cefotetan, Cefoxitin: also Gram - anaerobes (B. fragilis)
44
3rd generation cephalosporin coverage
``` 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 ```
45
4th generation cephalosporin coverage
broad Gram - activity (HNPEK, CAPES, pseudomonas) | Gram + coverage similar to ceftriaxone
46
5th generation cephalosporin coverage
Gram - activity similar to ceftriaxone broad gram + activity only beta-lactam to cover MRSA
47
1st generation cephalosporins (3)
cefazolin cefhalexin cefadroxil
48
2nd generation cephalosporins (5)
``` cefuroxime cefotetan cefaclor cefoxitin cefprozil ```
49
3rd generation cephalosporins group 1 (7)
``` cefdinir ceftriaxone cefotaxime cefditoren cefixime cefpodoxime ceftibuten ```
50
3rd generation cephalosporins group 2 (3)
ceftazidime ceftazidime/avibactam ceftolozane/tazobactam
51
4th generation cephalosporins (1)
cefepime
52
5th generation cephalosporins (1)
ceftaroline
53
cephalosporins have a cross-reactivity with what allergy
PCN
54
common use of cephalexin (2)
skin infection: MSSA | strep throat
55
common use of cefuroxime (3)
acute otitis media CAP sinus infection
56
common use of cefdinir (2)
CAP | sinus infection
57
common use of cefazolin
surgical prophylaxis
58
cefotetan and cefoxitin have what abnormal coverage
B. fragilis (anaerobic coverage)
59
common use for cefotetan and cefoxitin
surgical prophylaxis (colorectal)
60
what cephalosporin can have a disulfiram-like reaction with alcohol
cefotetan
61
common use of ceftriaxone and cefotaxime (4)
CAP meningitis SBP pyelonephritis
62
Does ceftriaxone have renal dose adjustment
No
63
what is the only beta-lactam active against MRSA
ceftaroline
64
``` Carbapenem coverage (2) No coverage (5) ```
most Gram + & Gram - anaerobic pathogens NO atypical, MRSA, VRE, C. diff, stenotrophomonas
65
Ertapenem has no activity to? (3)
Pseudomonas Acinetobacter Enterococcus
66
carbapenem caution in which population
dec. seizure control
67
All carbapenems cover what two organisms
ESBLs | pseudomonas-except ertapenem
68
All carbapenems do not cover (5)
``` atypicals VRE MRSA C. diff stenotrophomonas ```
69
Name monobactams (1)
aztreonam
70
MOA of aztreonam
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
Aztreonam activity
many Gram - Pseudomonas No Gram +
72
Aminoglycoside MOA
bind to the ribosome which intereferes with bacterial protein synthesis and results in a defective bacterial cell membrane
73
Aminoglycoside coverage
Gram - , pseudomonas
74
traditional dosing for aminoglycosides
lower doses more frequently
75
Extende interval dosing for aminoglycosides
higher doses to attain higher peaks less frequently this decreases nephrotoxcity
76
toxicity of aminoglycosides (2)
nephrotoxicity | ototoxicity
77
list carbapenems (4)
doripenem imipenem/cilastin meropenem ertapenem
78
Aminoglycoside dose adjustment on body weight
underweight: use total body weight obese: use addjusted body weight
79
Quinolone MOA
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
``` Respiratory quinolones (3) why are they called this? ```
gemifloxacin levofloxacin moxifloxacin -b/c enhanced coverage of S. pneumonia and atypical coverage
81
which quinolones cover pseudomonas
ciprofloxacin | levofloxacin
82
Which quinolone cannot treat UTIs
Moxifloxacin
83
Which quinolone has acitivity against MRSA
Delafloxacin
84
Quinolones and warfarin
inc. warfarin concentration
85
Quinolones and hypoglycemic drugs
inc. effects of hypoglycemic drugs
86
Antipseudomonal Quinolones (2)
ciprofloxacin | levofloxacin
87
Macrolides MOA
bind to the 50s ribosomal subunit resulting in inhibition of RNA-dependent protein synthesis
88
Macrolides coverage
``` atypicals -legionella -chlamydia -mycoplasma -mycobacterium avium complex Haemophilus ```
89
Macrolides are common treatment for (2)
CAP | STIs (chlamydia, gonnorrhea)
90
List macrolides (3)
azithromycin clarithromycin erythromycin
91
tetracycline MOA
inhibit bacterial protein synthesis by reversibly binding to the 30s ribosomal subunit
92
Tetracyclines coverage
Gram + (staph, trep, enterococci, nocardia, bacillus, propionibacterum) Gram - including respiratory flroa (Haemophilus, Moraxella, atypicals) spriochetes rickettsiae Bacillus anthracis treponema
93
Doxycycline indications
``` RTI (CAP) tick/rickettsial disease STI MRSA skin infection VRE UTI ```
94
Minocycline indications
skin infections including acne
95
What is one major caution in using a tetracycline
do not use in those <8 years can suppresses bone growth and skeletal development and permanently discolors teeth
96
Sulfonamides MOA
inhibit dihydrofolic acid formation from para-aminobenzoic acid, which interferes with bacterial folic acid synthesis
97
Trimethoprim MOA
inhibits dihydrofolic acid reduction to tetrahydrofolate, resultin gin inhibition of the folic acid pathway
98
Bactrim coverage
``` staphlyococci (MRSA, CA-MRSA) S. pneumoniae Gram - (broad) Shiqella Salmonella Stenotrophomonas opportunisitc pathogens (nocardia, pneumonocytis, toxoplasmosis) NO coverage: psedumonas, enterococci, anaerobes ```
99
Bactrim & Warfarin
INR increased when used with warfarin
100
glycopeptide MOA
inhibit bacterial cell wall synthesis by binding to the D-alanyl-D-alanine cell wall precursor and blocking peptidoglycan polymerization
101
Vancomycin coverage
Gram + only | -MRSA, streptococci, enterococci (not VRE), C. difficile
102
lipoglycopeptides MOA
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
List lipoglycopeptides (3)
telavancin oritavancin dalbavancin
104
Daptomycin coverage
Gram + (MRSA, enterococci [VRE])
105
Which condition can daptomycin not be used
pneumonia b/c due is inactivated by lung surfactant
106
Oxazolidinones MOA
bind to the 50s subunit of te bacterial ribosome, inhibiting translation and protein synthesis
107
Oxazolidinones list (2)
linezolid | tedizolid
108
Oxazolidinones coverage
Gram + and VRE
109
Quinupristin/dalfopristin MOA
bind to the 50s ribosomal subnit inhibiting protein synthesis
110
Quinupristin/dalfopristin coverage
Gram + (MRSA, VRE not E. faecalis)
111
Tigecycline MOA
binds to the 30s ribosomal subnit inhibitin gprotein synthesis, structurally related to the tetracycliens
112
Tigecycline coverage
Gram + (MRSA, VRE) Gram - (no activity against the 3Ps: pseudomonas, proteus, providenica) anaerobes atypical
113
Tigecycline indication (3)
SSTi IAI CAP
114
list polymyxins (2)
colistin | polymyxin B
115
polymyxin coverage
Gram -
116
Chloramphenicol MOA
binds to 50s subunit jof bacterial ribosome inhibiting protein synthesis
117
Chloramphenicol coverage
Gram + & Gram - anaerobes aytpical
118
Clindamycin MOA
reversibly binds to the 50s subunit of the bacterial ribosome inhibiting proetin synthesis
119
Clindamycin coverage
anaerobes Gram + NOT cover: Enterococcus, Gram -
120
Metronidazole MOA
cause a loss of helical DNA structure and strand breakage resulting in inhibition of protein synthesis
121
Metronidazole coverage
anaerobes | protozoal infections
122
Fidaxomicin MOA
inhibits RNA polymerase, resulting in inhibition of proetin synthesis and cell death
123
Fidaxomicin indication
C. diff
124
Rifaximin MOA
inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase
125
Rifaximin coverage
E. Coli
126
Fosfomycin MOA
inhibits bacterial cell wall synthesis by inactivating the enzyme pyruval transferase which is critical in the synthesis of cell walls
127
Fosfomycin Indication
UTI
128
Fosfomycin coverage
E. coli (ESBL) | E. Faecalis (VRE)
129
Nitrofurantoin MOA
bacterial cell wall inhibitor
130
Nitrofurantoin indication
uncomplicated UTI
131
Nitrofurantoin coverage
``` E. coli klebsiella Enterobacter S. aureus Enterococcus (VRE) ```
132
Nitrofurantoin Contraindication
CrCl < 60
133
Mupirocin ointment indication
eliminate staphylcocci MRSA colonization of the nares
134
Do lipophilic or hydrophilic antimicrobials have better tissue penetration
lipophilic

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