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Infectious Disease > Infectious Disease Part 1: Background and Antibiotics by Drug Class > Flashcards

Infectious Disease Part 1: Background and Antibiotics by Drug Class Flashcards

1
Q

Describe Gram-Positive Stain

A
  1. Appears dark purple
  2. Thick cell wall
  3. Crystal violet stain
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2
Q

Describe Gram-Negative Stain

A
  1. Appears pink
  2. Thin cell wall
  3. Safranin counterstain
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3
Q

If a patient has a gram stain that’s described as being Gram-Positive cocci clusters, what could be the possible species?

A
  1. Staphylococcus spp.

including MRSA, and MSSA

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4
Q

If a patient has a gram stain that’s described as being Gram-Positive cocci pairs & chains, what could be the possible species?

A
  1. Strep. Pneumoniae (diplococci)
  2. Streptococcus spp. (including strep pyogenes)
  3. Enterococcus spp. (including VRE)
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5
Q

If a patient has a gram stain that’s described as being Gram-Positive Rods, what could be the possible species?

A
  1. Listeria Monocytogenes
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6
Q

If a patient has a gram stain that’s described as being Gram-Positive Anaerobes, what could be the possible species?

A
  1. Peptostreptococcus
  2. Actinomyces spp.
  3. Clostridium spp.
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7
Q

If a patient has a gram stain that’s described as being Gram-Negative cocci, what could be the possible species?

A
  1. Neisseria spp.
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8
Q

If a patient has a gram stain that’s described as being Gram-Negative Rods that colonize gut “enteric”, what could be the possible species?

A
  1. Proteus Mirabilis
  2. E. Coli
  3. Klebsiella spp.
  4. Serratia spp.
  5. Enterobacter cloacae
  6. Citrobacter spp.
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9
Q

If a patient has a gram stain that’s described as being Gram-Negative Rods that DO NOT colonize gut, what could be the possible species?

A
  1. Pseudomonas Aerigunosa
  2. Haemophilus Infuenzae
  3. Providencia spp.
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10
Q

If a patient has a gram stain that’s described as being Gram-Negative Rods that are curved or spiral shaped, what could be the possible species?

A
  1. H. pylori, Campylobacter spp., Treponema spp.,

2. Borrelia spp., Leptospira spp.

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11
Q

If a patient has a gram stain that’s described as being Gram-Negative Coccobacilli, what could be the possible species?

A
  1. Acinetobacter Baumannii
  2. Bordetella Pertussis
  3. Moraxella Catarrhalis
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12
Q

If a patient has a gram stain that’s described as being Gram-Negative Anaerobes, what could be the possible species?

A
  1. Bacteroides fragilis

2. Prevotella spp.

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13
Q

What are some common resistant pathogens?

A

Hint: Kill Each and Every Strong Pathogen

  1. Klebsiella pneumoniae (ESBL,CRE)
  2. E.Coli ( ESBL,CRE)
  3. Acinetobacter baumannii
  4. Enterococcus Faecalis/Faecium (VRE)
  5. Staphylococcus areus (MRSA)
  6. Pseudomonas aeruginosa
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14
Q

What happens with C. diff infections?

A
  • Healthy GI flora is attacked by the antibiotic

- Overgrowth of resistant pathogens

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15
Q

What are the symptoms for C.diff infection?

A
  1. abdominal cramping
  2. Colitis
  3. diarrhea
    * symptoms can be fatal*
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16
Q

All antibiotics can cause C.diff infections. Which antibiotic has a BBW for it?

A

Clindamycin (Cleocin)

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17
Q

Which ABX are DNA/RNA inhibitors?

A

Hint: Quin Met Tiny Rapid

  1. Quinolones (DNA gyrase, topoisomerase IV)
  2. Metronidazole (Flagyl)
    Tinidazole (Tindamax)
  3. Rifampin
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18
Q

Which ABX are Cell Membrane inhibitors?

A

Hint: P - DOT

  1. Polymyxin (colistimethate)
  2. Daptomycin (Cubicin)
  3. Telavancin (Vibativ)
  4. Oritavancin (Orbactiv)
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19
Q

Which ABX are Protein Synthesis inhibitors?

A

Hint: CQ- MALT

  1. Clindamycin (Cleocin)
  2. Quinupristin/Dalfopristin
  3. Macrolides
  4. Aminoglycosides
  5. Linezolid, Tedizolid (Sivextro)
  6. Tetracyclines
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20
Q

Which ABX are Cell Wall inhibitors?

A

Hint: BMV

  1. Beta lactams (penicillins, cephalosporins, carbapenems)
  2. Monobactams (aztreonam)
  3. Vancomycin, dalbavancin (Dalvance), telavancin, oritavancin
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21
Q

Which ABX are Folic Acid Synthesis Inhibitors?

A

Hint: STD

  1. Sulfonamides
  2. Trimethoprim*
  3. Dapsone (Aczone)
    * Often combined with SMX to overcome resistance
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22
Q

Hydrophilic Agents Characteristics

A
  1. Small VD
  2. Renal elimination
  3. Low intracellular concentrations
  4. Increased clearance in sepsis
  5. Poor-moderate bioavailability
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23
Q

What are the hydrophilic agents?

A

Hint: BAG-PD

  1. Beta lactams
  2. Aminoglycosides
  3. Glycopeptides
  4. Daptomycin
  5. Polymixins
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24
Q

sLipophilic Agents Characteristic

A
  1. Large Vd
  2. Hepatic metabolism
  3. Achieve intracellular concentrations
  4. Clearance changed minimally in sepsis
  5. Excellent bioavailability
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25
Q

What are the Lipophilic Agents?

A

Hint: Quin Made Really Light Chicken Tacos

  1. Quinolones
  2. Macrolides
  3. Rifampin
  4. Linezolid
  5. Chloramphenicol
  6. Tetracycline
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26
Q

BETA-LACTAM ABX: PENICILLINS

Natural Penicillins

  1. What are they?
  2. What do they cover?
A
  1. Penicillin G

2. Covers Gram-Positive cocci, Gram-Positive anaerobes

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27
Q

BETA-LACTAM ABX: PENICILLINS

Aminopenicillins

  1. What are they?
  2. What do they cover?
A
  1. Amoxicillin, Ampicillin

2. Adds Gram-negative coverage (HNPEK)

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28
Q

BETA-LACTAM ABX: PENICILLINS

Aminopenicillins + Beta-Lactamase Inhibitor

  1. What are they?
  2. What do they cover?
A
  1. Amoxicillin/Clavulanate, ampicillin/sulbactam

2. Adds MSSA, more resistant strains of HNPEK, Gram-negative anaerobes (B. fragilis)

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29
Q

BETA-LACTAM ABX: PENICILLINS

Extended Spectrum + Beta Lactamase Inhibitor

  1. What are they?
  2. What do they cover?
A
  1. Piperacillin/tazobactam

2. Adds CAPES, Pseudomonas

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30
Q

BETA-LACTAM ABX: PENICILLINS

Antistaphylococcal

  1. What are they?
  2. What do they cover?
A
  1. Nafcillin, Oxacillin

2. Covers MSSA and Streptococci ONLY

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31
Q

BETA-LACTAM ABX: PENICILLINS

Class Trend?

A
  1. They all cover enterococcus (accept antistaphylococcal PCNs)
  2. Do not cover atypicals or MRSA
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32
Q

SELECT PENICILLINS (DRUG TABLE)

Natural Penicillins

  1. PO:
  2. IV:
    3: IM:
A
  1. PO: Penicillin V Potassium
  2. IV: Penicillin G Aqueous
    3: IM: Penicillin G Benzathine (Bicillin L-A)
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33
Q

SELECT PENICILLINS (DRUG TABLE)

Aminopenicillins

  1. PO:
  2. IV:
A
  1. PO: Amoxicillin (Moxatag)

2. IV: Ampicillin

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34
Q

SELECT PENICILLINS (DRUG TABLE)

Aminopenicillins + Beta-Lactamase Inhibitor

  1. PO:
  2. IV:
A
  1. PO: Amoxicillin/Clavulanate (Augmentin)

2. IV: Ampicillin/Sulbactam (Unasyn)

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35
Q

SELECT PENICILLINS (DRUG TABLE)

Extended Spectrum + Beta Lactamase Inhibitor

  1. IV:
A
  1. IV: Piperacillin/Tazobactam (Zosyn)
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36
Q

SELECT PENICILLINS (DRUG TABLE)

Antistaphylococcal

  1. PO:
  2. IV:
A
  1. PO: Dicloxacillin

2. IV: Nafcillin, Oxacillin

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37
Q

PENICILLINS

Class effects?

A
  1. Beta-Lactam allergy
  2. Risk of seizures

🚨 If patient has either of these avoid PCNs 🚨

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38
Q

PENICILLINS

Penicillin VK

Outpatient Oral indications?

A
  1. Strep throat

2. Mild skin infections

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39
Q

PENICILLINS

Amoxicillin (Moxatag)

Outpatient Oral indications?

A
  1. Acute Otitis Media (90 mg/kg/day)
  2. Infective endocarditis prophylaxis
  3. H. pylori
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40
Q

PENICILLINS

Amoxicillin/Clavulanate (Augmentin)

Outpatient Oral indications?

A
  1. Acute Otitis Media (90 mg/kg/day)

2. Lowest dose of clavulanate

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41
Q

PENICILLINS

Penicillin G Benzathine (Bicillin L-A)

Inpatient Oral indications?

A
  1. Syphilis
  2. Never use IV

** IM only**

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42
Q

PENICILLINS

Piperacillin/Tazobactam (Zosyn)

Inpatient Oral indications?

A
  1. Only penicillin active against Pseudomonas

2. Extended-infusion common

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43
Q

PENICILLINS

Nafcillin, Oxacillin, Dicloxacillin

Inpatient Oral indications?

A
  1. MSSA and streptococcus (MRSA)

2. No renal adjustment needed

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44
Q

CEPHALOSPORINS

1st Generation

  1. IV:
  2. PO:
  3. Coverage:
A
  1. IV: Cefazolin
  2. PO: Cephalexin (Keflex)
  3. Coverage: Staphylococci, Streptococci, PEK, mouth anaerobes
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45
Q

CEPHALOSPORINS

2nd Generation

  1. IV/IM/PO:
  2. Coverage:
A
  1. IV/IM/PO: Cefuroxime (Ceftin)
  2. Coverage:
    - Better Gram-negative activity (HNPEK)
  • Cefotetan and Cefoxitin have anaerobic activity (B. fragilis)
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46
Q

CEPHALOSPORINS

3rd Generation

Group 1:

  1. IV:
  2. PO:
  3. Coverage:

Group 2:

  1. IV:
  2. Coverage:
A

GROUP 1:

  1. IV: Ceftriaxone
  2. PO: Cefdinir
  3. Coverage: Less Staphylococci coverage, but better Streptococci coverage

GROUP 2:

  1. IV: Ceftazidime, Ceftazidime/Avibactam
  2. Coverage: Pseudomonas
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47
Q

CEPHALOSPORINS

4th Generation

  1. IV:
  2. Coverage:
A
  1. IV: Cefepime

2. Coverage: Broad-spectrum: Gram-positives, HNPEK, CAPES, Pseudomonas

48
Q

CEPHALOSPORINS

5th Generation

  1. IV:
  2. Coverage:
A
  1. IV: Ceftaroline (Teflaro)

2. Coverage: Similar to ceftriaxone but with MRSA coverage

49
Q

CEPHALOSPORINS

Class trends?

A
  1. No Enterococcus coverage

2. Do not cover atypicals

50
Q

CEPHALOSPORINS

Class Effects?

A
  1. Beta-Lactam allergy
  2. Risk of seizures

🚨 If patient has either of these avoid PCNs 🚨

51
Q

CEPHALOSPORINS

Outpatient (Oral)

1st Generation: Cephalexin

Indications?

A
  1. Strep throat

2. MSSA skin infections

52
Q

CEPHALOSPORINS

Outpatient (Oral)

2nd Generation: Cefuroxime

Indications?

A
  1. Acute Otitis Media
  2. CAP
  3. Sinus Infections
53
Q

CEPHALOSPORINS

Outpatient (Oral)

3rd Generation: Cefdinir

Indications?

A
  1. CAP

2. Sinus Infection

54
Q

CEPHALOSPORINS

Inpatient (Parenteral)

1st Generation: Cefazolin

Indications?

A
  1. Surgical Prophylaxis
55
Q

CEPHALOSPORINS

Inpatient (Parenteral)

2nd Generation: Cefotetan, Cefoxitin

Indications?

A
  1. Surgical Prophylaxis (GI Procedures)

2. Cefotetan: Disulfram-like reactions

56
Q

CEPHALOSPORINS

Inpatient (Parenteral)

3rd Generation: Ceftriaxone and Cefotaxime

A
  1. CAP
  2. Meningitis
  3. SBP
  4. Pyelonephritis

Ceftriaxone: no renal dose adjustment, 🚨 DO NOT USE IN NEONATES🚨

57
Q

CEPHALOSPORINS

Inpatient (Parenteral)

5th Generation: Ceftaroline

Coverage?

58
Q

CARBAPANEMS

Class Effects?

A
  1. ESBL-producing organisms
  2. Pseudomonas (except Ertapenem)
  3. Beta-lactam allergy and seizures
  4. All IV (NS only for ertapenem)
59
Q

CARBAPANEMS

What do they NOT cover?

A
  1. Atypicals
  2. VRE
  3. MRSA
  4. *ErtAPenem does not cover PEA
60
Q

CARBAPANEMS

What are the common uses?

A
  1. Polymicrobial Infections

2. Empiric treatment when MDR pathogens suspected

61
Q

MONOBACTAMS

Aztreonam

  1. Formulation?
  2. Who can use it?
  3. Coverage?
A
  1. IV ONLY
  2. Can be used in pts with beta-lactam allergy
  3. Gram-negative coverage, including Pseudomonas
62
Q

AMINOGLYCOSIDES

Coverage?

A
  1. Gram-negatives, including Pseudomonas

2. Synergy for Gram positives (Staphylococci/Enterococci)

63
Q

AMINOGLYCOSIDES

Dosing

  1. Traditional?
  2. Extended Interval?
A
  1. Traditional: 1 - 2.5 mg/kg IV Q8H

2. Extended Interval: 4 -7 mg/kg IV Q24H

64
Q

AMINOGLYCOSIDES

Dosing

  1. What is monitored for traditional dosing?
  2. What is monitored for extended interval dosing?
A
  1. Peaks and troughs

2. Draw a random level and use nomogram

65
Q

AMINOGLYCOSIDES

What needs to be monitored?

A
  1. Renal Function

2. Serum Levels

66
Q

AMINOGLYCOSIDES

Good News?

A

Kill Gram-negative, synergistic with beta-lactams for Gram-positive infections, low resistance and cost

67
Q

AMINOGLYCOSIDES

Bad News?

A

Toxicities: renal damage and ototoxicity

68
Q

AMINIGLYCOSIDES

Smart Idea when using them?

A

Concentration-dependent killing ➡ give larger doses less frequently (extended - interval dosing) ➡ allow the kidneys to recover

69
Q

AMINOGLYCOSIDES

Traditional Dosing: Target Drug

  1. When should the Trough be drawn?
  2. When should the Peak be drawn?
A
  1. 30 min before 4th dose

2. 30 min after the end of 4th dose infusion

70
Q

AMINOGLYCISIDES

Gentamicin/Tobramycin

  1. Peak?
  2. Trough?
A
  1. 5-10 mcg/mL

2. <2 mcg/mL

71
Q

QUINILONES

Are they concentration-dependent killing?

72
Q

QUINOLONES

Boxed Warnings?

A
  1. Tendon Rupture
  2. Peripheral Neuropathy
  3. CNS effects (including seizures)
  4. Use last-line (only if no alternatives)
73
Q

QUINOLONES

Warnings?

A
  1. QT Prolongations
  2. Hypo and Hyperglycemia
  3. Psychiatric disturbances
  4. Photosensitivity
  5. Avoid use in children (risk vs. benefit)
74
Q

QUINOLONES

Interactions?

A
  1. Chelation with divalent cations (Fe2+, Ca2+,Mg2+)
75
Q

QUINOLONES

Respiratory Quionolones

  1. Coverage
  2. What are they?
A
  1. active against S. pneumoniae
  2. Hint: My Good Lungs
    • Levofloxacin
    • Gemifloxacin
    • Moxifloxacin (IV:PO=1:1, not renally adjusted, 🚨do not use for UTIs🚨)
76
Q

QUINOLONES

Antipseudomonal Quinolones

  1. What are they?
  2. Indications?
A
    • Levofloxacin (IV:PO=1:1)
  • Ciprofloxacin
    • Pseudomonas infections
  • UTI
  • Intra-abdominal infections
  • Traveler’s diarrhea
77
Q

QUINOLONES

Profile Review Tips?

A
  1. Caution in patients with CVD, ⬇K/Mg, use of other QT-prolonging drugs
  2. Avoid if seizure history or using an antiepileptic drug
  3. Avoid in children
  4. Watch for tendon rupture, neuropathy, CNS/psychiatric side effects
78
Q

MACROLIDES

Agents in class?

A
  1. Azithromycin (Zithromax)
  2. Clarithromycin (Biaxin)
  3. Erythromycin (E.E.S)
79
Q

MACROLIDES

Coverage?

A
  1. Atypical pathogens (Legionella, Chlamydia, Mycoplasma, Mycobacterium avium)
  2. H. influenzae
  3. S. pneumoniae
80
Q

MACROLIDES

Common Uses?

A
  1. CAP

2. Strep throat

81
Q

MACROLIDES

Azithromycin Indications?

A
  1. COPD exacerbations
  2. Chlamydia
  3. Gonorrhea
  4. MAC prophylaxis
82
Q

MACROLIDES

Clarithromycin Indications?

83
Q

MACROLIDES

Erythromycin Indications?

A
  1. increase gastric motility
84
Q

MACROLIDES

Azithromycin Dosing (Z-Pak)

A

500 mg (two 250 mg tabs) on day 1, then 250 mg daily x 4 days

85
Q

MACROLIDES

Safety Issues

  1. QT prolongation:
  2. Drug interactions:
A
  1. QT prolongation: caution with CVD, ⬇ K/Mg, use of other QT-prolonging drugs
  2. Clarithromycin/erythromycin contraindicated with simvastatin/lovastatin
86
Q

TETRACYCLINES

Agents in class?

A
  1. Doxycycline (Vibramycin)
  2. Minocycline (Minocin, Solodyn)
  3. Tetracycline
87
Q

TETRACYCLINES

Coverage?

A
  1. S. aureus (including CA-MRSA)
  2. H. influenzae, Moraxella, atypiclas +/- S. pneumo
  3. Rickettsiae
  4. H. pylori
  5. VRE
88
Q

TETRACYCLINES

Common Uses:

A
  1. CA-MRSA skin infections

2. Acne

89
Q

TETRACYCLINES

Doxycycline Indications:

A
  1. Tick-borne infections
  2. CAP
  3. COPD exacerbations
  4. sinusitis
  5. VRE
  6. UTI
  7. Chlamydia
  8. Gonorrhea
90
Q

TETRACYCLINES

Tetracycline Indications:

A
  1. H. pylori treatment
91
Q

TETRACYCLINES

Safety Issues

A
  1. Avoid use in children age < 8 years, pregnancy and breastfeeding
  2. Photosensitivity
  3. Interaction with divalent cations
  4. IV:PO = 1:1
  5. Minocycline: DILE
92
Q

SULFONAMIDES

  1. What is dose based on?
  2. Dose for Uncomplicated UTI?
A
  1. Dose based on TMP

2. 1 DS tablet PO BID x 3 days

93
Q

SULFONAMIDES

Contraindications?

A

Do not use if sulfa allergy, pregnant or breastfeeding

94
Q

SULFONAMIDES

Warnings:

A
  1. Skin reactions (including SJS/TEN)

2. G6PD deficiency

95
Q

SULFONAMIDES

Side effects?

A
  1. Photosensitivity
  2. ⬆ K
  3. Hemolytic anemia (positive Coombs test)
  4. Crystalluria
96
Q

SULFONAMIDES

SMX/TMP (oral)

Common Uses

A
  1. Ca-MRSA infections
  2. UTI
  3. Pneumocystis pneumonia
97
Q

SULFONAMIDES

SMX/TMP (oral)

5: 1 Ratio SMX/TMP
1. SS tablet =
2. DS tablet =

A
  1. SS tablet = 80 mg TMP

2. DS tablet = 160 mg TMP

98
Q

SULFONAMIDES

SMX/TMP (oral)

Sulfa Allergy reactions?

A
  1. Rash/Hives common

2. Can cause severe SJS reactions (SJS/TEN)

99
Q

SULFONAMIDES

SMX/TMP (oral)

What happens when used with warfarin?

100
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

Vancomycin Coverage?

A
  1. Gram-positives (MRSA)
  2. Streptococci
  3. Enterococci
  4. C. difficile (PO only)
101
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

Vancomycin Dosing?

A

IV: 15-20 mg/kg Q8-12H, using TBW

Dose/interval adjustment in renal failure

102
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

Vancomycin Monitoring?

A
  1. Scr and avoid other nephrotic or ototoxic drugs

e. g., furosemide, aminoglycosides, cisplatin

103
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

Vancomycin Indications?

A

1st line for MRSA infections

e.g., pneumonia, meningitis, bacteremia, some skin infections

104
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

Vancomycin target trough for severe infections?

A

15 - 20 mcg/mL

105
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

Vancomycin

What can occur with rapid infusion?

A
  1. Red man syndrome
106
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

Vancomycin PO indication?

A

Only for C. difficile infections

  • 125 mg QID x 10 days
107
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

What toxicity can Vancomycin cause?

A
  1. Ototoxicity

2. Nephrotoxicity

108
Q

ANTIBIOTICS FOR GRAM-POSITIVE INFECTIONS

If the MIC for vancomycin is >2 what happens?

A

You do NOT use the vancomycin

109
Q

LIPOGLYCOPEPTIDES

What are the agents?

A
  1. Telavancin
  2. Oritavancin
  3. Dalbavancin
110
Q

LIPOGLYCOPEPTIDES

Coverage?

A

similar to IV vancomycin

111
Q

LIPOGLYCOPEPTIDES

Indications?

A
  1. Approved for skin infections

2. Televancin approved for HAP/VAP

112
Q

LIPOGLYCOPEPTIDES

What can they all cause?

A

Redman syndrome

113
Q

LIPOGLYCOPEPTIDES

Which ones are single-dose regimens?

A
  1. Oritavancin

2. Dalbavancin

114
Q

LIPOGLYCOPEPTIDES

Boxed Warnings?

A
  1. Fetal risk
  2. Nephrotoxicity
  3. ⬆ mortality compared to vancomycin in pneumonia trials (patients with CrCl = 50 mL/min)
115
Q

LIPOGLYCOPEPTIDES

Contraindications

  1. Televancin:
  2. Oritavancin:
A
  1. concurrent use of IV UFH

2. use of IV UFH for 5 days after

116
Q

LIPOGLYCOPEPTIDES

Warnings

  1. Televancin:
  2. Oritavancin:
A
  1. falsely ⬆ aPPT/PT/INR

2. ⬆ PT/INR (up to 12 hours) and ⬆ aPTT (up to 120 hours)

Infectious Disease (1 decks)

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