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Pediatric Pharmacology Exam 2 > Infectious Disease Quiz > Flashcards

Infectious Disease Quiz Flashcards

1
Q

General considerations for antibiotic choice (4)

A
  1. Cost
  2. Insurance
  3. Administration (IV vs PO vs q8 vs q24)
  4. Patient population (antibiogram)
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2
Q

Medication considerations (5)

A
  1. Combination (synergy)
    Ex: PCN + Aminoglycosides for pseudonomas
  2. Antibiotic susceptibility
  3. Empiric therapy
    Ex: Vancomycin for pneumococcal meningitis
    *Broad spectrums are often used for empiric therapy
  4. Targeted “narrow” treatment
  5. Diagnostic tests
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3
Q

Diagnostic Tests (7)

A
  1. Gram stain (gram negative or positive)
  2. Cultures (growth of causative organism and susceptibility)
  3. Serology (titers or antibodies measured)
  4. CBC (elevation in WBC)
  5. PCR testing
  6. Sensitivity testing (some bacteria are resistant to certain antibiotic classes)
  7. Minimum inhibitory concentration (lowest concentration of antibacterial agent to prevent growth; predicts bacteriological response)
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4
Q

Pharmacokinetic efficacy of antibiotics (3)

A

Relies on….

  1. Time-dependent kinetics: the amount of time the serum concentration remains above the MIC
  2. Concentration-dependent kinetics: the highest concentration in the serum reached, must greatly exceed the MIC
  3. Post antibiotic efficacy: delayed regrowth of bacteria following antibiotic therapy
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5
Q

Pharmacodynamic efficacy of antibiotics (3)

A
  1. Bactericidal –> destroys the microbes
    Ex: PCN
  2. Bacteriostatic –> inhibits growth but doesn’t destroy
    * Needs an immunological response to eliminate organisms
  3. Both
    * Some antibiotics exhibit both properties depending on concentration in the blood
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6
Q

Routes of Administration Considerations for Antibiotics (5)

A
  1. Bioavailability
  2. Severity of infection
  3. Location of infection
  4. Organ function
  5. Drug levels required
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7
Q

Patient considerations when choosing antibiotics (5)

A
  1. Age
  2. Immune function
  3. Allergies
  4. Response to antibiotics (improving or worsening?)
  5. ADEs
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8
Q

Narrow spectrum antibiotics

A
  1. Active against limited groups of pathogens

2. Generally, may only work against gram(-) or gram(+) but not both

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9
Q

Broad spectrum antibiotics

A
  1. Active against a wide range of pathogens
  2. Often used for empiric therapy
  3. Generally, has activity against both gram negative and gram positive
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10
Q

Aerobic vs. anaerobic bacteria

A

Aerobic: grow and live in presence of oxygen

Anaerobic: grow and live in absence of oxygen

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11
Q

Gram Positive Bacteria Characteristics (5)

A
  1. Thick peptidoglycan cell wall
    POSITIVE=THICK
  2. Smooth cell wall
  3. Does NOT contain an outer lipid membrane
  4. Cocci
  5. Bacilli
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12
Q

Gram Negative Bacteria Characteristics (6)

A
  1. Think peptidoglycan cell wall
    NEGATIVE=THIN
  2. Wavy cell wall
  3. Contains a thick lipid membrane
  4. Coccobacilli
  5. Cocci
  6. Bacilli
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13
Q

Antibiotics that treat gram(+) bacteria (7)

A
  1. Aminopenicillin
  2. First generation cephalosporins (Cefazolin)
    EXCEPT for Enterococcus bacteria
  3. Vancomycin
    Tx of choice for MRSA
  4. Fourth generation antibiotics (cefepime)
    - although these are best for gram negative
  5. Aminoglycosides ONLY in combination with other drugs
  6. Linezolid (Zyvox)- specific product needed
  7. Licosamides (Clindamycin)
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14
Q

Antibiotics that treat gram(-) bacteria (7)

A
  1. First generation cephalosporins (Cefazolin) treat proteus, E.coli, Klebsiella bacteria
  2. Second generation cephalosporins (Cefoxitin and Cefuroxime)
  3. Third generation cephalosporins
    - Cefoxatime
    - Ceftriaxome
    - Cefazidime
    - Cefotaxime
    - cefpodoxime
    - Cefixime
    - Cefidinir
  4. Fourth generation cephalosporins exhibit great gram(+) and gram(-) activity BUT are the best for gram(-)
    - Drug name: Cefepime
  5. Aminoglycosides
    * Used in combo to treat gram(+) such as endocarditis but if it is used alone it’s for gram(-)
    - Amikacin
    - Gentamicin
    - Tobramycin
    - Streptomycin
  6. Fluoroquinolones
    - Ciprofloxacin, Levofloxacin, Moxifloxacin, Ofloxacin
  7. Monobactam (Aztreonam)
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15
Q

Antibiotics that treat gram positive and gram negative bacteria (6)

A
  1. PCN
  2. ESPCN
  3. B-lactam/b-lactamase inhibitors
  4. Cephalosporins – mainly 4th gen but also some 1st
  5. Carbapenems
    - broadest spectrum of all antibiotics**
  6. Sulfonamides (Suflamethoxazole)
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16
Q

Which antibiotics treat pseudonomas? (4)

A
  1. Carbapenems
    - Imipenem
    - Meroenem
    - Doripenem
    - Ertapenem
  2. Aminoglycosides – Tobramycin especially
  3. Fluoroquinolones (variable pseudonomas coverage)
    - CIPROFLOXACIN IS 1ST LINE AGENT
  4. Some 3rd gen cephalosporins but not all
    - Ceftazidime is only one
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17
Q

What antibiotics treat E.Coli? (2)

A
  1. 1st generation cephalosporins
    - Cefazolin (IV)
    - Cephalexin (oral)
    - Cefadroxil (oral)
  2. Fluoroquinolones
    - Ciproflaxin
    - Levofloxacin
    - Moxifloxacin
    - Ofloxacin
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18
Q

What antibiotics treat MSA and MRSA? (6, and 2 to never use)

A
  1. Vancomycin = TX OF CHOICE FOR MRSA!
  2. Daptomycin
  3. Clindamycin
  4. Suflonamides (Sulfamethoxazole)
  5. Tetracyclines
  6. Fluoroquinolones covers MSA but not MRSA

NEVER USE:

  1. PCN
  2. Carbapenems
19
Q

What antibiotics treat Stenotrophomans? (1, and 1 to never use)

A

Sulfonamides (Sulfamethoxazole)! Drug of choice for stenotrophomans

Never use carbapenems

20
Q

What antibiotics treat anaerobic bacteria? (4 and one to never use)

A
  1. Extended spectrum PCN (ESPCN)
    - Only available as IV (Piperacillin or Ticaricillin)
  2. 2nd generation cephalospprins
    - Only available as IV (Cefoxiltin or Cefotetan)
  3. Clindamycin
  4. Metronidazole

NEVER USE Fluoroquinolones (drugs that end in -oxacin)

21
Q

What drugs treat atypical organisms?

A

MACROLIDES

  • Erytrhomycin
  • Azithromycin
  • Clarithromycin
22
Q

What weight based dosing is sulfamethoxazole/trimethoprin dosed off sulfamethoxazole or trimethoprin?

A

TRIMETHOPRIN

  • IV requires more frequent dosing than PO
  • PO dosing is typically q12h
23
Q

PCN Adverse Effects (7)

A
  1. Rash (usually delayed)
  2. Seizures (rare)
  3. Abd discomfort
  4. Neutropenia
  5. Fever (drug induced fever)
  6. Acute renal failure (AKI)
  7. Elevated LFTs (oxacillin and nafcillin)
24
Q

Cephalosporin ADEs (6)

A
  1. Rash (usually delayed)
  2. Seizures (rare)
  3. Abd discomfort
  4. Neutropenia
  5. Fever (drug induced fever)
  6. Biliary sludging (with ceftriaxone) – ceftriaxone can bind to calcium in the bloodstream leading to cholelethiasis and blockage of the gallbladder; rare
25
Q

Aminoglycoside ADEs (2)

A
  1. Nephrotoxicity (renal tubular damage)

2. Ototoxicity (irreversible)

26
Q

Sulfonamide ADEs (7)

A
  1. Rash
  2. Photosensitivity
  3. Nephrotoxicity
  4. Obstructive uropathy
  5. Neutropenia
  6. Thrombocytopenia
  7. Hyperkalemia
27
Q

Fluoroquinolone ADEs (5)

A
  1. Photosensitivity
  2. Seizures (rare)
  3. Abd discomfort
  4. QTc interval prolongation
  5. CNS stimulation
28
Q

Fluoroquinolone BBWs (3)

A
  1. Tendon rupture
  2. Peripheral neuropathy
  3. CNS effects
29
Q

Tetracycline ADEs (4)

A
  1. Stained teeth
  2. Abd discomfort
  3. Photosensitivity
  4. Absorption may be decreased with foods and metallic cations
30
Q

Macrolide ADEs (3)

A
  1. Ototoxicity (rare)
  2. Abd discomfort
  3. Taste disturbances
31
Q

Licosamides (Clindamycin) ADEs (2)

A
  1. Abd discomfort - pseudomembranous colitis

2. Tastes bad

32
Q

Metrodinazole ADEs (5)

A
  1. Peripheral neuropathy
  2. Taste disturbances
  3. Disulfiram reaction
  4. Seizures (rare)
  5. Abd discomfort
33
Q

Vancomycin ADEs (4 and 1 info)

A
  1. Ototoxicity (rare)
  2. Nephrotoxicity
  3. Red-man syndrome
  4. Neutropenia

Info:
5. Requires serum level monitoring for efficacy and safety

34
Q

Linezolid ADEs (4)

A
  1. Thrombocytopenia
  2. Peripheral neuropathy
  3. Optic neuropathy
  4. Lactic acidosis
35
Q

Daptomycin ADEs (2)

A
  1. CPK elevations

2. Myopathies (avoid in combo with statins)

36
Q

Azole Antifungal mechanism of action

A

Inhibits ergosterol synthesis (main sterol in fungal cell wall) to prevent cell wall growth

  1. Fluconazole
  2. Ketoconazole (topical)
  3. Voriconazole
37
Q

Fluconazole spectrum of activity (3)

A

anti-fungal for

  1. Candida
  2. Cyptococcus
  3. Blastomyces
38
Q

Voriconazole spectrum of activity (3)

A

anti-fungal for

  1. Candida
  2. Aspergillus
  3. Mold
39
Q

Azole ADEs (6)

A
  1. Increase in LFTs
  2. Abd pain (generally well tolerated)
  3. N/V (generally well tolerated)
  4. QT prolongation

Specific to Voriconazole:

  1. CNS hallucinations or visual disturbances
  2. Increased SCr
40
Q

What is TOBI?

A

Tobramycin; inhaled antibiotic (aminoglycoside) mainly used for pseudonomas infection

*Approved for outpatient use in CF patients with P.aeruginos

41
Q

What is valganciclovir primarily used for?

A

Cytomegalovirus

*Take with high fat meal to increase absorption

42
Q

Which viruses does acyclovir and valacyclovir work against?

A
  1. Herpes simplex virus 1 and 2

2. Varicella Zoster virus

43
Q

ADEs of Valacyclovir and Acyclovir (4)

A
  1. With acyclovir you can see increased SCr and acute kidney failure (rare but more common with IV)
  2. Malaise
  3. Headache
  4. With valacyclovir you can see increased LFTs

Pediatric Pharmacology Exam 2 (9 decks)

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