Infectious Disease Background Flashcards
1
Q
Common bacterial pathogens for infections in
CNS/Meningitis
A
Strep pneumo N meningitidis H. influ Group B strep/E coli (young) Listeia (young/old)
2
Q
Common bacterial pathogens for infections in
Upper respiratory
A
Strep pyogenes
Strep pneumo
H. influ
Moraxella catarrhalis
3
Q
Common bacterial pathogens for infections in
heart/endocarditis
A
Staph aureus (MSSA, MRSA)
Staph epidermidis
Streptococci
Enterococci
4
Q
Common bacterial pathogens for infections in
Skin/soft tissue
A
Staph aureus
Strep pyogenes
Staph epidermidis
Pasturella multocida +/- aerobic/anaerobic GNR (diabetics)
5
Q
Common bacterial pathogens for infections in
Bone and joint
A
Staph aureus Staph epidermidis Strep N gonorrhoeae GNR
6
Q
Common bacterial pathogens for infections in
Mouth
A
mouth flora (peptostreptococcus, actinomyces) Anaerobic GNR (prevotella) Viridans group strep
7
Q
Common bacterial pathogens for infections in Lower respiratory (community acquired)
A
Strep pneumo
H. influ
Atypicals (legionella, mycoplasma)
Enteric GNR (alcoholics)
8
Q
Common bacterial pathogens for infections in Lower respiratory (hospital acquired)
A
Staph aureus (including MRSA)
Pseudomonas
Enteric GNR
Strep pneumo
9
Q
Common bacterial pathogens for infections in
urinary tract
A
E. coli, proteus, klebsiella
Staph saprophyticus
Strep
Enterococci
10
Q
What color do gram positive organisms stain?
A
Purple
11
Q
What color do gram negative organisms stain?
A
Pink
12
Q
What color do atypicals stain?
A
They don’t stain - no cell wall
13
Q
What organisms are
gram positive cocci clusters?
A
Staphlococcus (MSSA, MRSA)
14
Q
What organisms are
tram positive cocci pairs (diplococci) and chains (cocci)
A
Strep pneumo
Strep
Enterococcus
15
Q
What organisms are
gram positive rods (bacilli)
A
Lysteria
16
Q
What organisms are
gram positive anaerobes (spores)
A
peptostreptococcus
Actinomyces
Clostridium
17
Q
What organisms are
atpyicals?
A
Chlamydia
Legionella
Mycoplasma pneumoniae
Mycobacterium tuberculosis
18
Q
What organisms are
gram negative cocci
A
Nesseria
19
Q
What organisms are
gram negative anaerobes
A
bacteriodes fragilis
Prevotella
20
Q
What organisms are
gram negative coccobacilli
A
Acinetobacter baumannii
Bordetella pertussis
Moraxella catarrhalis
21
Q
What organisms are
gram negative rods (gut)
A
Proteus mirabilis E coli Klebsiella Serratia Enterobacter cloacae Citrobacter
22
Q
What organisms are
gram negative rods (not gut)
A
Pseudomonas aeruginosa
H. influ
Providencia
23
Q
What organisms are
gram negative curved or spiral shaped rods
A
H. pylori Campylobacter Spp Treponema spp Borrelia spp Leptospira spp
24
Q
Which 2 antibiotics can be used to treat certain invasive gram-positive infections?
A
aminoglycosides and beta lactams
25
How are ESBL infections treated?
carbapenems or cephalosporin/beta-lactamase inhibitors
26
How are CRE (carbapenem resistant enterobacteriaceae) treated?
Polymyxins
27
Common resistant pathogens
```
Kill Each And Every Strong Pathogen
Klebsiella pneumo (ESBL, CRE)
E coli (ESBL, CRE)
Acinetobacter baumannii
Enterococcus (VRE)
Staph aureus (MRSA)
Pseudomonas
```
28
Which abx are folic acid synthesis inhibitors?
Sulfonamides
Trimethoprim
Dapsone
29
Which abx are Cell wall inhibitors
Beta lactams
Monobactams
Vancomycin, dalbavancin, televancin, oritavancin
30
Which abx are protein synthesis inhibitors
```
Aminoglycosides
Macrolides
Tetracyclines
Clindamycin
Linezolid, tedizolid
Quinupristin/Dalfopristin
```
31
Which abx are cell membrane inhibitors
polymyxins
daptomycin
telavancin
oritavancin
32
Which abx are DNA/RNA inhibitors
quinolones
metronidazole, tinidazole
rivampin
33
Which abx have concentration-dependent killing?
| What is the PK goal and what are the dosing strategies?
Aminoglycosides, quinolones, daptomycin
Goal: high peak, low trough
Large doses, long intervals
34
Which abx have AUC:MIC dependent killing?
| What is the PK goal and what are the dosing strategies?
Vancomycin, macrolides, tetracyclines, polymyxins
Goal: exposure over time
Variable dosing strategies
35
Which abx have Time>MIC dependent killing?
```
Beta lactams (PCN, cephalosporins, carbapenems)
Goal: maintain drug level > MIC for most of the dosing interval
Dosing strategies: shorter dosing interval, extended or continuous infusion
```
36
What drugs are aminopenicillins and what are they active against?
Amoxicillin +/- clavulanate, ampicillin +/- sulbactam
Streptococci, enterococci, gram-positive anaerobes (mouth flora) plus gram negative Haemophilus, neisseria, proteus, E. coli
+ BLI have added activity against MSSA, klebsiella (HNPEK) and gram-negative anaerobes (b fragilis)
HNPEK
37
What drugs are natural penicillins and what are they active against?
Penicillin V, PCN G aqueous, PCN G benzathine
| strep and enterococci (NOT STAPH) and gram positive anaerobes (mouth flora)
38
What drugs are extended spectrum penicillins and what are they active against?
Piperacillin/tazobactam
Gram-positive (strep, MSSA, enterococci) Gram-positive anaerobes (mouth flora), gram-negative anaerobes (B fragilis) PLUS citrobacter, acinetobacter, providencia, enterobacter, serratia (CAPES) and pseudomonas
HNPEK CAPES
39
What drugs are antistaphylococcal penicillins and what are they active against?
Dicloxacillin, nafcillin, oxacillin
| Strep, MSSA
40
beta lactam MOA
inhibit bacterial cell wall synthesis by binding to penicillin binding proteins, preventing the final step of peptidoglycan synthesis in bacterial cell wall
41
What medications are beta lactam antibiotics?
PCN, caphalosporins, carbapenems
42
Which PCN has a boxed warning and what is it?
Penicillin G benzathine
| Not for IV use - can cause cardiorespiratory arrest and death
43
PCN contraindications, side effects, monitoring
Augmentin and Unasyn: hx of cholestatic jaundice or hepatic dysfunction with previous use
CrCl < 30, do NOT use extended release oral forms or 875mg strength of amox/clav
SE: seizures (accumulation), GI upset, diarrhea, rash (SJS/anaphylaxis), hemolytic anemia, renal failure, increased LFTs
Monitoring: renal fxn, CBC and LFTs with prolonged use
44
When switching from IV ampicillin to PO, what medication should be chosen?
amoxicillin b/c ampicillin has poor PO bioavailability
45
What is the only thing IV ampicillin can be diluted in?
NS
46
How much sodium does zosyn contain?
65 mg per 1g piperacillin
47
Which PCN is a vesicant? How do you treat it's extravasation?
Nafcillin (administer through central line preferred)
| Cold packs and hyaluronidase injections
48
Which penicillins do not require renal adjustments?
Antistaphylococcal (diclox, naf, oxacillin)
49
What are some drug interactions with PCN abx
Probenecid - increase beta lactam levels (interfere with renal excretion)
Warfarin (except naf and diclox) - increase INR
Increase level of methotrexate
Decrease level of mycophenolate
50
Which patients should penicillins be avoided in?
Pts with beta lactam allergy
51
What is there an increased risk of with accumulation of any PCN antibiotic?
seizures
52
What is PCN VK first-line for?
strep throat and mild nonpurulent skin infections (no abscess)
53
What is amoxicillin first line for?
otitis media, infective endocarditis prophylaxis before dental procedures, H. pylori
54
What is PCN G benzathine first line for?
syphilis
55
What is Amox/clav first line for?
acute otitis media and sinus infections
56
What is the only PCN that is active against pseudomonas?
pip/tazo
57
What are first gen cephalosporins and what do they cover?
Cefazolin, cephalexin
| Gram positive cocci (strep and staph - MSSA), Proteus, E. coli, Klebsiella (PEK)
58
What are second gen cephalosporins and what do they cover?
cefuroxime, cefotetan
Staph, Strep, Haemophilus, neisseria, proteus, e. coli, klebsiella (HNPEK)
Cefotetan and cefoxitin - gram negative anaerobes (B. fragilis)
59
What are third gen cephalosporins and what do they cover?
cefdinir, ceftriaxone, cefotaxime, ceftazidime
Ceftriaxone, cefotaxime: Strep, staph (MSSA), gram positive anaerobes (mouth flora)
Ceftazidime: pseudomonas
Ceftaz/avibactam and ceftolozane/tazo: MDR pseudomonas
60
What are fourth gen cephalosporins and what do they cover?
Cefepime
MRSA (only beta-lactam that covers this)
Gram negative (HNPEK, CAPES, pseudomonas)
Gram positive (strep, staph, mouth flora)
61
What are fifth gen cephalosporins and what do they cover?
Ceftaroline
MRSA (only beta-lactam that covers this)
Gram negative (HNPEK, CAPES, pseudomonas)
Gram positive (strep, staph, mouth flora)
62
What adverse effect can occur if there is cephalosporin accumulation?
Seizures - watch for in renal failure
63
What cephalosporine does not need renal adjustment?
ceftriaxone - excreted renally and hepatically but liver picks up if kidneys are slacking
64
What is the only beta lactam active against MRSA?
ceftaroline
65
What types of infections are carbapenems used for?
multidrug resistant gram-negative
66
What drugs are carbapenems?
Dori, imi, mero, ertapenem
67
What carbapenem does not cover pseudomonas, acinetobacter or enterococcus?
ertapenem
| ErtAPenem
68
What is imipenem combined with and why?
cilastatin
| prevents drug degredation by renal tubular dehydropeptidase
69
What antibiotics should not be used in someone with a PCN allergy?
Penicillins, cephalosporins, carbapenems,
70
Class effect of carbapenems
Cover ESBL producing organisms
Cover pseudomonas except ertapenem
Do not use with PCN allergy
Seizure risk with high dose and renal failure
71
What do carbapenems NOT cover?
Atypicals, VRE, MRSA, C. diff, stenotrophomonas
72
Common uses for carbapenems
```
Polymicrobial infections (broad)
Empiric therapy when resistant organisms are suspected
Resistant pseudomonas or acinetobacter (except ertapenem)
```
73
What is the only monobactam?
aztreonam
74
Aztreonam MOA
inhibits bacterial cell wall synthesis by binding to PCN binding protein (PBP) which prevents peptidoglycan synthesis in bacterial cell walls
75
Why is cross reactivity unlikely between Aztreonam and PCN?
Aztreonam only has one circle (monobactam) in its structure
76
What does aztreonam cover?
```
Gram negative (including pseudomonas)
does NOT cover gram positive or anaerobic activity
```
77
Aminoglycoside MOA
bind to ribosome preventing bacterial protein synthesis causing defective cell membrane
78
What bacteria are AG active against?
gram negative (including pseudomonas)
79
What AG are used with beta lactams or vancomycin for synergy? What infections is this used to treat?
gentamycin and streptomycin
| Gram positive infections
80
Which type of dosing is attributed to less accumulation of AG? traditional or extended?
extended
81
BBW for AG?
nephrotoxicity, ototoxicity, avoid with other neurotoxic/nephrotoxic meds, neuromuscular blockade and respiratory paralysis
82
AG warnings and SE?
Warnings: caution in impaired renal function, elderly, and using other nephrotoxic drugs
SE: nephrotoxicity, hearing loss, vestibular toxicity (balance issues)
83
Quinolones MOA
inhibit bacteiral DNA topoisomerase IV and DNA gyrase (topoisomerase II) preventing supercoiling of bacteria and promotes breakage of DNA
84
What abx are concentration dependent?
AG and FQ
85
What bacteria do quinolones cover?
Gram positive, negative, and atypicals
86
What are the respiratory quinolones? What do they have an increased coverage of?
Levo, moxi, and gemifloxacin
| Strep pneumo and atypical
87
What FQ are used in combo with beta lactam when treating pseudomonas?
cipro and levofloxacin
88
What is the only FQ that cannot be used to treat UTI?
moxifloxacin
89
What is the only FQ that does not have a high resistance to MRSA?
Delafloxacin
| Newer to the market
90
BBW for FQ
tendon inflammation and/or rupture within hours/days or up to several months after, peripheral neuropathy, CNS effects (seizures, tremor, hallucinations, etc)
91
FQ warnings and SE
warnings: QT prolongation, hypo/hyperglycemia, psychiatric disturbances, photosensitivity
92
What patients should FQ not be used in?
Pregnant and children
| Risk of musculoskeletal toxicity
93
What medications interact with FQ
Antacids (polyvalent cations chelate)
Lanthanum (Fosrenol) and sevelamer (Renvela)
Warfarin (increase INR)
Sulfonylureas (increase effect and cause hypoglycemia)
Probenecid and NSAIDs increase FQ levels
94
Do not administer ciprofloxacin with what medication?
Tizanidine
95
What is the only FQ that is not renally adusted?
Moxifloxacin
96
What medications are macrolides?
Azithromycin, clarithromycin, erythromycin
97
Macrolide MOA
bind 50S robosomal subunit, inhibiting RNA dependent protein synthesis
98
What do macrolides cover?
atypicals and haemophilus
99
Macrolide CI
Hepatic dysfunction
100
What medication should NOT be given with clarithromycin and erythromycin
lovastatin or simvastatin
101
Macrolide Warnings and SE
Warnings: QT prolongation, hepatotoxicity
SE: GI upset, ototoxicity
102
What macrolides go through what CYP enzymes?
Erythromycin and clarithromycin major CYP3A4 inhibitors
Azithromycin 3A4 substrate and 1A2 inhibitor
103
Azithromycin common uses
COPD exacerbations
Chlamydia monotherapy
Gonorrhea combo therapy
Travelers diarrhea
104
Clarithromycin common uses
H. pylori
105
What drugs are tetracyclines
Doxycycline, minocycline
106
Tetracycline MOA
inhibit protein synthesis by reversibly binding to 30S ribosomal subunit
107
What do tetracycline cover?
gram-negative, atypicals
108
What tetracycline does not need to be renally adjusted?
Doxycycline
109
Tetracycline warnings
photosensitivity
Children <8 years, pregnancy, breastfeeding
minocycline: drug-induced lupus erythematosis (DILE)
110
Tetracycline drug interactions
Antacids/polyvalent cations
Lanthanum (Fosrenol) - decreases tetracycline
Use with caution in CYP3A4 inhibitors (increase levels) and CYP3A4 inducers (decrease levels)
Warfarin - increase INR
111
Sulfonamides abx and MOA
TMP/SMX
SMX - inhibits dihydrofolic acid formation and interferes with bacterial folic acid synthesis
TMP - inhibits folic acid pathway
112
What does bactrim cover?
Staph (MRSA and CA-MRSA), gram negative, pneumocystis, toxoplasmosis
113
Bactrim CI
Sulfa allergy, pregnancy (b/c folic acid), anemia d/t folate deficiency
114
Bactrim warnings and SE
Warnings: skin reactions (SJS/TEN), G6PD deficiency
SE: photosensitivity, hyperkalemia, hemolytic anemia, crystalluria
115
What CYP enzymes does bactrim go through? What significant drug does it interact with
2C8 and 2C9 inhibitor
| Increase INR when used with warfarin
116
Vancomycin MOA
inhibits bacterial cell wall synthesis by binding D-alanyl-D-alanyl cell wall precursor and blockign peptidoglycan polymerization
117
What bacteria does vancomycin cover?
gram positive - MRSA, strep, enterococci (not VRE), and C. diff
118
What antibiotic is used to treat C. diff?
ORAL vancomycin
| IV vanc will NOT work
119
Vancomycin warnings and SE
Warnings: ototoxicity and nephrotoxicity, infusion reaction (red man syndrome)
SE: phlebitis, skin reactions
120
What abx are lipoglycopeptides?
Telavancin
Oritavancin
Dalbavancin
121
Lipoglycopeptide MOA
inhibit bacterial cell wall synthesis by binding to D-alanyl-D-ALANINE blocking polymerization and cross-linking of peptidoglycan and disrupting bacterial cell membrane potential and changing permeability
122
Telavancin BBW
Fetal risk, nephrotoxicity
123
Lipoglycopeptide CI, warnings, SE
CI: concurrent use of UFH (except dalbavancin)
Warnings: can falsely elevate PT/INR
SE: Telavancin - metallic taste, N/V, foamy urine, increase SCr; Oritavancin/Dalbavancin - infusion reaction (red man syndrome)
124
Daptomycin MOA
inhibits protein synthesis through rapid depolarization of cell membrane --> cell death
125
What bacteria does daptomycin work against?
gram positive including MRSA and VRE
126
Daptomycin warnings and SE
Warnings: myopathy and rhabdomyolysis, can fasely increase PT/INR but does not increase bleeding risk, neuropathy, eosinophilic pneumonia
SE: increased CPK, rash, edema, chest pain, HTN, AKI
127
Why does daptomycin not work in the lungs?
Drug is inactivated by the surfactant
128
What drugs are oxazolidinones
Linezolid (Zyvox) and tedizolid (Sivextro)
129
Oxazolidinones MOA
bind to 5OS subunit of ribosome inhibiting translation and protein synthesis
130
Oxazolidinones vs vancomycin coverage
Same (gram positive and MRSA) except oxazolinones cover VRE
131
Oxazolidinones contraindication
Do not use within 2 weeks of MAOI
132
Oxazolidinones warnings and SE
Warnings: duration related myelosuppression, peripheral and optic neuropathy when >28 days use, serotonin syndrome, hypoglycemia
SE: decreased platelets, Hgb, WBC, HA, N/D, increased LFTs
133
Oxazolidinones interactions
Avoid tyramine containing foods and serotonergic drugs
134
Synercid generic name
quinupristin/dalfopristin
135
quinupristin/dalfopristin class
streptogramin
136
quinupristin/dalfopristin MOA
binds to 50S ribosomal subunit inhibiting protein synthesis
137
What does quinupristin/dalfopristin cover?
Gram positive including MRSA and VRE but NOT E. faecalis
138
Why is quinupristin/dalfopristin not usually used?
Not well tolerated
139
quinupristin/dalfopristin SE
SE: arthralgias/myalgias, infusion reaction, phlebitis, hyperbilirubinemia (all above 35%), CPK elevations, GI upset, increased LFTs
***administer via central line
140
What can daptomycin be diluted in?
NS but NOT DEXTROSE
141
What can quinupristin/dalfopristin be diluted in?
D5 ONLY
142
Tigecycline class and MOA
Glycylcycline
| Binds 30S ribosomal subunit inhibiting protein synthesis
143
Tigecycline works against what bacteria?
Gram-positive including MRSA and VRE, gram-negative, anaerobes, and atypicals
Does not work against the 3 P's: pseudomonas, proteus, providencia
144
Tigecycline BBW, warnings, and SE
BBW: increased risk of death (LAST LINE ONLY)
Warnings: hepatotoxicity, pancreatitis, photosensitivity, teeth discoloration in children <8
SE: N/V/D, HA, dizziness, increased LFTs, SJS
145
What type of infections should tigecycline not be used for and why?
bloodstream - super lipophilic so does not reach adequate concentrations in bloodstream
146
What drugs are polymyxins
Colistimethate sodium and polymyxin b
147
Polymyxin MOA
Colistin (cationic detergent) damages bacterial cytoplasmic membrane causing leakage of intracellular substances and cell death
148
Polymyxin coverage
gram-negative (not proteus)
| Usually used for MDR gram-negative pathogens in combo with other abx
149
Polymyxin BBW and warnings
Colistimethate sodium
Warning: dose dependent nephrotoxicity, neurotoxicity
Polymyxin BBW: nephrotoxicity, neurotoxicity, respiratory paralysis from neuromuscular blockade
150
What polymyxin is a prodrug and what is it metabolized to?
colistin (colistimethate) is hydrolyzed to colistin (cationic detergent)
151
Chloramphenicol MOA
reversibly binds to 50S subunit of the baterial ribosome inhibiting protein synthesis
152
Chloramphenicol coverage
gram positive, gram negative, anaerobes, and atypicals
153
Chloramphenicol BBW and warnings
BBW: serious and fatal bloody dyscrasias (aplastic anemia, pancytopenia)
Warnings: gray syndrome with high serum levels - circulatory collapse, yanosis, acidosis, abdominal distention, myocardial depression, coma, death
154
Clindamycin MOA
reversibly binds to 50S subunit of bacterial ribosome inhibiting protein synthesis
155
Clindamycin coverage
most anaerobes and gram-positive bacteria
156
Clindamycin BBW, warnings, SE
BBW: C. diff
Warning: severe or fatal skin reactions
SE: N/V/D, rash, increased LFTs
157
Nitroimidazole drugs
Metronidazole, tinidazole, secnidazole
158
nitroimidazole MOA
cause loss of helical DNA structure and strand breakage resulting in inhibited protein synthesis
159
Metronidazole activity
anaerobes and protozoal infections
| Bacterial vaginosis, trichomoniasis, giardiasis, amebiasis, D. diff, and intra-abdominal infections
160
nitroimidazole BBW, CI, Warnings, SE
BBW: possibly carcinogenic
CI: pregnancy (first trimester), alcohol or propylene glycol use during or within 3 days after treatment
Warnings: CNS effects (seizures, peripheral neuropathy) metronidazole can cause aseptic meningitis, encephalopathy, or optic neuropathy
SE: metallic taste, HA, nausea, furry tongue, darkened urine, dizziness, rash/SJS
161
Lefamulin MOA
inhibits bacterial protein synthesis by binding to the peptidyl transferase center of the 50S ribosomal subunit
162
Lefamulin CI, warnings, SE
CI: use with CYP3A4 substrates that prolong the QT interval
Warnings: avoid in pregnancy, QTc prolongation, C diff
SE: diarrhea, nausea, injection site reaction
163
Fidaxomicin MOA
inhibits RNA polymerase, resulting in inhibition of protein synthesis and cell death
164
Fidaxomicin warnings and SE
Warnings: not effective for systemic infections (No IV dosage)
SE: N/V, abdominal pain, GI bleeding, anemia
165
Rifaximin MOA
inhibits bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase
166
Rifaximin SE and notes
SE: peripheral edema, dizziness, HA, flatulence, nausea, abdominal pain, rash
Notes: not effective for systemic infections; used off-label for C. diff
167
Fosfomycin MOA
inhibits bacterial cell wall synthesis by inactivating the eyzyme pyruval transferase, disrupting cell wall synthesis
168
Fosfomycin coverage
E. coli (including ESBL) and E. faecalis (including VRE)
169
What is fosfomycin used for?
```
UTI - single dose for uncomplicated
1 packet (3g) mixed in 3-4 oz water
```
170
Nitrofurantoin MOA
bacterial cell wall inhibitor
171
Nitrofurantoin coverage
E. coli, Klebsiella, Enterobacter, S. aureus, and VRE
| ***used for UTI
172
Nitrofurantoin dosing
MacroBID is used BID
| Macrodantin is QID
173
Nitrofurantoin CI, warnings, and SE
CI: renal impairment (CrCl < 60)
Warnings: optic neuritis, hepatotoxicity, peripheral neuropathy, pulmonary toxicity, hemolytic anemia (caution in pts with G6PD deficiency)
SE: GI upset, HA, rash, brown urine (harmless)
174
What is mupirocin used for?
Nasal ointment used to eliminate MRSA colonization of nares
175
What ORAL abx need to be refrigerated after reconstitution?
Penicillin VK
Ampicillin
Amox/clav
Vanc
176
What ORAL abx should NOT be refrigerated after reconstitution?
Cefdinir
177
What IV abx should not be refrigerated?
Metronidazole, moxifloxacin, bactrim, acyclovir
