Infectious Disease I Flashcards
Gram-positive organisms
gram-stain?
cell-wall?
- purple
- thick
Gram-negative organisms
gram-stain?
cell-wall?
- pink
- thin
Gram positive cocci consists of ____ and ___?
Cluster and Chains
Name the bacteria?
gram-stain purple
cocci
CLUSTERS
Staphylococcus spp.
including MSSA and MRSA
Name the bacteria?
gram-stain purple
CHAINS or PAIRS
Strep. pneumoniae
Streptococcus spp.
Enterococcus spp. (including VRE)
Name the bacteria?
gram-stain purple
anaerobes
PAC
P-Peptostreptococcus
A-Actinomyces spp.
C- C.diff
Name the bacteria?
Atypicals
gram-stain?
Chlamydia spp.
Legionella spp.
Mycoplasma pneumoniae
Mycobacterium tuberculosis
HNPEK
Identify the “gut colonizers” vs. “NON-gut colonizers”
H- H. influenzae (non -gut colonizer) N- Neisseria spp. (Cocci) P- Proteus (gut colonizer) E- E. coli (gut colonizer) K- Klebsiella spp. (gut colonizer)
CAPES + ____ + ____
Identify the shape (cocci, rod, etc..)
C- Citrobacter spp. A- Acinetobacter baumanni P- Providencia E- Enterobacter S- Serratia spp.
MOUTH flora- Peptostreptococcus (gram +) and Actinomyces
Pseudomonas
Cell-wall inhibitors (3)
- Beta-lactams (Penicillins, cephalosporins, carbapenems)
- Monobactams
- Vancomycin
Folic-Acid Inhibitors
- Sulfonamides
- Bactrim
Cell-membrane inhibitors a.k.a Lipoglycopeptides + ____
Televancin Daptomycin Oritavancin PLUS Polymyxin
DNA/RNA Inhibitors
- Quinolones (floxacins)- DNA gyrase/TOPO IV)
- Metronidazole
- Rifampin
Protein Synthesis Inhibitors
- Aminoglycosides
- Macrolides (mycins)
- Tetracylcines (doxy,mono,tetra)
- Clindamycin
- Linezolid
Name the TIME dependent antibiotics?
- Beta-lactams
- Penicillins
- Cephlasporins
- Carbapenems
Note: all others are CONCENTRATION dependent
What Beta-lactam is commonly used to treat syphilis?
Pen G (Bicillin LA)- IM formulation only This is a lipid emulsion that can be deadly if given IV
What natural penicillin is used to treat gram (+) cocci, anaerobes, and skin infections?
Penicillin VK
What Beta-lactams are commonly used to treat AOM? What is the dosing?
Amoxicillin and Augmentin
90 mg/kg/day
Note: clavulate is the lowest dose
____ is an Aminopenicillin used to PROPHylactically treat infective endocarditis (dental surgery)?
Amoxicillin
What is the only beta-lactam (ESBL) that covers pseudomonas AND CAPES?
Zosyn (pipercillin/tazobactam)
All Beta-lactams cover Enterococcus accept for these? Do they require renal dose adjustment?
Oxacillin (PO)
Naficillin, Dicloxacillin (IV)
No renal dose adjustment required
Aminopenicillins cover what organisms?
HNPEK
Penicillin Class Effects
- Beta-lactam allergy
- Risk of seizures (more common in patients with decrease renal fxn which leads to accumulation or Hx of seizures)
Name the aminopenicillin + Betalactamase inhibitors (PO and IV formulation) combos and what do they cover?
Augmentin- amoxicillin/clavulanate (PO)
Unasyn- ampicillin/sulbactam (IV)
Coverage:
MSSA, HNPEK, B. fragilis
What is the only exception when considering initiating penicilin therapy in a patient with a penicillin allergy?
Pregnant patients with syphiliis
What medications classes/drugs would be inappropriate treatment for a patient with a hx of seizures?
Beta-lactams (Penicillins, Cephalosporins,Carbapenems)
Quinolones
Bupropion
What monolactam can be used when patient has an allergy to penicillin?
Aztreonam
When can cephalosporins be used in a child with a penicillin allergy?
When the child has AOM
1st gen cephalosporins; formulation; coverage?
1st Gen Cephalosporins:
Cefazolin (IV); Cephlexin (PO)
Coverage:
- PEK (gram -)
- mouth anaerobes (peptostreptococci)
Name the 2nd generation cephalosporin that comes in IV/PO/IM. What does it cover?
Cefuroxime (Ceftin)
Coverage:
-HNPEK
Name the two 2nd generation (IV) cephalosprins and their coverage?
CeFOTetan and CeFOXitin
Coverage:
B. fragilis
Which 2nd generation (IV) cephalosprins is associated with DISULFIRAM rxns? What is it used to treat?
CeFOTetan
Treament for:
AOM
CAP
sinus infection
What cephalosporin has strep pneumo coverage + MRSA?
Ceftaroline (Teflaro)
What IV cephalosporin treats gram +, HNPEK, and CAPES ~ including pseudomonas?
4th generation
Cefepime (IV)
What IV cephalosporin treats CAP, SBP, and pyelonephritis and does not require renal dose adjustment? contraindications? What is the PO formulation?
Ceftriaxone -IV (3rd generation)
- in neonates (0-28 days)
Cefdinir-PO (3rd generation)
T/F?
Beta-lactams cover ATYPICALS?
False
-beta-lactams are cell-wall inhibitors and atypicals LACK a cell wall.
All carbapenems cover psuedomonas except ______?
Ertapenem
- DOES NOT cover PEA and must be put in NS
Carbapenem class effects?
- ESBL producing organisms
- DO NOT COVER MRSA, VRE or Atypicals
What are the 2 major aminoglycoside toxicities?
Traditional dosing?
Extended Interval dosing?
Trough goal?
Ototoxicity and Nephrotoxicity
Traditional: 1.5 to 5 mg/kg IV q8h
Extended interval: 4 to 7 mg/kg q24h
Trough goal: < 2 mcg/mL
Quinolone Boxed Warnings and additional warnings?
- Tendon rupture
- Peripheral neuropathy
- CNS effects (SEIZURES, paranoia, nightmares)
- QT prolongation
- HYPER/HYPO -glycemia
- photosensitivity
- AVOID in children < 8 years of age, prego, breastfeeding due to teeth discoloration and bone growth retardation
- LAST LINE TX
Name the respiratory quinolones?
My Good Lungs
M- Moxifloxacin
G- Gemfloxacin
L-Levofloxacin
What do quinolones and Macrolides have in common when considering SE profiles?
QT prolongation Cation interactions (avoid Fe, Mg, Ca, antacids)
What 2 quinolones are anti-psuedomonal?
levofloxacin and ciprofloxacin
Which macrolides are contraindicated with lovastatin and simvastatin?
Erythromyin
Clarithromycin
What antibiotic is associated with G6PD deficiency and a positive COOMBS test?
What are indications of hemolytic anemia?
Bactrim
- positive Coombs Test
- decreasing hemoglobin/hematocrit
If susceptibility results extended spectrum beta-lactamase positive, what drug classes should be considered? (2)
Carbapenems
Cephalosporins + Beta-lactamase inhibitors (Zerbaxa and Avycaz)
What macrolide is commonly used to treat gonnorhea, chlamydia, traveler’s diarrhea and MAC?
Azithromax
Z-pak (250 mg)
Tri-pak (500 mg)
Why is Vancomycin infusions limited to 1 gram over one hour?
Red Man Syndrome caused by rapid infusion
-S & S include: rash, pruitus, erythema and, less frequently, hypotension or angiodema
What agent is indicated for the treatment of VRE E. faecalis?
Daptomycin (Cubicin)
What agent covers VRE E. faecium?
Synercid (Quinupristin and Dalfopristin)
T/F?
Linezolid covers VRE and MRSA.
True
Drug of choice for Acinetobacter?
Merepenem
What should be done if a Tobramycin levels are drawn and the peak is 8.4 mcg/mL and the trough is 2.4 mcg/mL?
ONLY extend dosing interval
What tetracycline is associated with BLE in addition to class related counseling including sun sensitivity and must be taken apart from antacids?
MINOcycline
