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Infectious Diseases Flashcards

1
Q

Ceftaroline Generation

A

5th gen

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2
Q

Ceftriaxone Generation

A

3rd gen

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3
Q

Cefepime Generation

A

4th gen

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4
Q

Cephalexin Generation

A

1st gen

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5
Q

Cefuroxime Generation

A

2nd gen

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6
Q

Cefprozil Generation

A

2nd gen

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7
Q

Cefazolin Generation

A

1st gen

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8
Q

Cefoxitin Generation

A

2nd gen

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9
Q

Ceftazidime Generation

A

3rd gen

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10
Q

Cefotaxime Generation

A

3rd gen

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11
Q

Ceftobiprole Generation

A

5th gen

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12
Q

Normal flora of the upper respiratory tract?

A
  • Streptococci
  • S. Aureus (nose)
  • Neisseria
  • Haemophilus
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13
Q

Normal flora of the skin?

A
  • Staphylococcus
  • Micrococcus
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14
Q

Normal flora of the mouth?

A
  • Streptococci
  • Candida
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15
Q

Normal flora of the intestines?

A
  • Bacteroidetes (bacteroides)
  • Firmicutes (lactobacillus + clostridium)
  • Actinobacteria (bifidobacterium)
  • Proteobacteria (enterobacteriaceae)
  • Candida
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16
Q

What is the Minimum Inhibitory Concentration (MIC)?

A

The lowest concentration of antibiotic at which there is no visible growth.

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17
Q

What is time dependent killing?

A

The duration of time the concentration of the drug is above the MIC is important for antibacterial effect.

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18
Q

What is concentration dependent killing?

A

The ratio of the drug exposure to the MIC (AUC/MIC) is important for antibacterial effect.

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19
Q

Gram negative bacteria?

A
  • all pseudomonas
  • E. coli
  • Salmonella
  • klebsiella pneumoniae
  • Neisseria
  • enterobacter aerugenes
  • (bonus) - Serratia sp., acinetobacter, xanthomonas, zymomonas, pantoea, vibrio cholera
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20
Q

Gram positive bacteria?

A
  • All staph and strep
  • Bifidobacterium
  • mycobacterium tuberculosis
  • enterococci
  • clostridium botulinum.
  • (bonus) - lactic acid bacteria, anthrax, hemolytic bacteria
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21
Q

Which drugs are beta-lactams (by class)?

A

Penicillins, cephalosporins, carbapenems.

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22
Q

Beta-lactams MOA?

A

Cell-wall inhibitor.

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23
Q

Drugs that act on cell walls typically have good activity against gram positive or gram negative bacteria?

A

Good gram-positive activity!

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24
Q

What does gram stain tell us about the thickness of the cell wall?

A

Gram positive = thick cell-wall
Gram negative = thin cell-wall

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25
Penicillin VK/Penicillin G coverage?
Very narrow spectrum. Poor coverage of gram-negatives.
26
Cloxacillin coverage?
Very narrow spectrum. Effective against staph sp.
27
Amoxicillin/Ampicillin coverage?
Narrow-ish spectrum (broader than penicillin and cloxacillin), effective against Strep and Enterococcus, intermediate against Staph.
28
How does resistance to beta-lactam's develop? what causes the resistance?
resistance develops when antimicrobials are used inappropriately. Resistance is caused by beta-lactamases.
29
Examples of beta-lactamase inhibitors?
Clavulanic acid, tazobactam, sulbactam
30
What types of bugs tend to produce beta-lactamases?
Generally gram negative bacteria produce them.
31
Amoxicillin spectrum?
Streptococci, enterococci, non-beta-lactamase producing organisms (e. coli, K. pneumoniae, H. influenzae)
32
Amoxicillin/Clavulanate spectrum?
Streptococci, Enterococci, Staphylococcus (not MRSA), anaerobes, some gram-negatives + beta-lactamase producing.
33
Cephalosporins 1st and 2nd gen coverage (Gram positive vs gram negative coverage)?
Better gram-positive coverage, weaker gram-negative coverage.
34
3rd and 4th generation coverage (gram positive vs gram negative)?
Better gram negative coverage, weaker gram positive coverage.
35
5th gen cephalosporins coverage?
Good for both gram positive and gram negative.
36
Where do fluoroquinolones work?
inside the cell - inhibit RNA and DNA synthesis.
37
Fluoroquinolones MOA?
Inhibit DNA topoisomerase.
38
When are fluoroquinolones used?
They are broad-spectrum and are typically reserved for treatment failure or allergy.
39
Examples of fluoroquinolones?
Ciprofloxacin, moxifloxacin, levofloxacin.
40
Clinical Pearl: When thinking of urinary bugs, which FQ should be used?
Ciprofloxacin. Can be used for gram-negative aerobes (E. coli, Klebsiella) and pseudomonas (notable gram-negative bug)
41
Clinical Pearl: when thinking of respiratory bugs, which FQ should be used?
Moxifloxacin, Levofloxacin. Used for enteric gram-negatives, S. pneumoniae (MSSA), pseudomonas (levofloxacin only), anaerobes (moxifloxacin only).
42
Where do tetracyclines work?
inside the cell.
43
What are some tetracyclines?
Doxycycline, Minocycline, Tetracycline.
44
Tetracycline MOA?
Bind bacterial ribosome and inhibits proteins synthesis.
45
Tetracyclines bug coverage?
- broad spectrum coverage of gram-positive organisms (but increasing resistance) - good coverage of atypicals - moderate coverage of MRSA, S. pneumoniae - NOT FOR Group A Strep (S. pyogenes)
46
Do macrolides work inside the cell or outside?
Inside the cell.
47
Macrolides MOA?
Bind bacterial ribosome + inhibits protein synthesis.
48
Examples of macrolides?
Clarithromycin, Azithromycin, erythromycin.
49
Macrolides coverage?
- Broad coverage of respiratory bugs BUT high resistance rates. - Good coverage of atypical and less-common respiratory bugs. - Only moderate coverage of S. pneumoniae (high rates of resistance).
50
Where does Clindamycin work?
Inside the cell.
51
Examples of lincosamides?
Clindamycin
52
Clindamycin MOA?
Bind bacterial ribosome and inhibits protein synthesis.
53
Clindamycin coverage?
- Good for gram-positive anaerobes, S. pyogenes - useful in penicillin allergic patients - Moderate coverage for S. aureus, including MRSA (increasing resistance)
54
Clinical Pearl: What are we concerned about with macrolides?
Drug interactions - ALWAYS check.
55
What is clindamycin notable for?
High rates of antibiotic-associated diarrhea and C. difficile diarrhea.
56
Example of Folate Antagonists?
Sulfamethoxazole/Trimethoprim
57
Sulfamethoxazole/Trimethoprim MOA?
inhibits folate synthesis which is required for DNA synthesis.
58
Sulfamethoxazole/trimethoprim bug coverage?
- S. aureus, including MRSA - Gram-negative bacilli (E. coli, K. pneumoniae) - UTIs!
59
Sulfamethoxazole/trimethoprim use?
Used less often as first line therapy due to unpredictable resistance. Culture is usually required.
60
Azolidines (class) drug?
Nitrofurantoin
61
Nitrofurantoin MOA?
Nitrofurantoin is metabolized to toxic metabolite in bacteria.
62
Nitrofurantoin elimination?
It is eliminated rapidly by the kidneys and moves to the bladder quickly.
63
Nitrofurantoin coverage?
- Used predominantly for UTIs. Excellent coverage of common UTI bugs (E. coli).
64
Fosfomycin MOA?
Inhibits bacterial wall synthesis.
65
Fosfomycin use?
One main use: UTIs.
66
Fosfomycin bug coverage?
E. coli
67
What antibiotic is a glycopeptide?
Vancomycin.
68
Vancomycin MOA?
Cell-wall inhibitor.
69
Vancomycin coverage?
- gram-positive only - MRSA, Enterococcus, Staphylococcus
70
Vancomycin concerns?
ototoxicity, nephrotoxicity, infusion-related reactions
71
What needs to be done when a patient is on vancomycin?
Therapeutic drug monitoring.
72
What antibiotics cover MRSA? (11)
- ceftaroline - tetracycline - doxycycline - minocycline - SMX/TMP - clindamycin - vancomycin - daptomycin - linezolid - fosfomycin - rifampin
73
What antibiotics are anti-pseudomonals? (12)
- Piperacillin-tazobactam - ceftazidime - cefepime - imipenem-cilastatin - meropenem - aztreonam - ciprofloxacin - levofloxacin - gentamicin - tobramycin - amikacin - colistimethate
74
What drugs are aminoglycosides?
Gentamicin, Tobramycin, amikacin
75
Aminoglycosides MOA?
bind irreversibly to the 30S subunit of the bacterial ribosome, which results in inhibition of protein synthesis and induction of translational errors (sorry its long).
76
Aminoglycosides coverage?
- gram-negative coverage (Pseudomonas, E. coli, klebsiella)
77
Aminoglycosides excretion?
High urine concentration (70% excreted unchanged)
78
What can we add to aminoglycosides to work synergistically?
Antibiotics that work on the cell wall.
79
What are we worried about with aminoglycosides?
Ototoxicity, nephrotoxicity
80
What must be done with aminoglycosides?
Therapeutic drug monitoring
81
What is valacyclovir commonly used for?
HSV - treatment or prophylaxis Varicella-zoster virus (VSV) - treatment
82
What is acyclovir commonly used for?
HSV - treatment
83
What is oseltamivir used for?
Influenza - only in specific cases
84
What is Nirmatrelvir-Ritonavir used for?
COVID-19
85
Metronidazole MOA?
Activated by anaerobic bacteria and protozoa into free radicals which cause DNA damage and eventually cell death.
86
Metronidazole use?
think of it as the "antibiotic scavenger". Covers organisms that other large classes don't. Good coverage of anaerobes, but poor coverage of aerobic.
87
Two types of antifungals?
Azoles and polyenes
88
What is an important target for antifungal drugs? Why?
Ergosterol because it is an important component of fungal cell membranes.
89
Azole antifungal MOA?
Inhibit ergosterol production in cell membrane.
90
What are some examples of azole antifungals?
Fluconazole, clotrimazole, ketoconazole
91
What is important to note about azole antifungals?
MANY drug interactions when taken orally.
92
What is an example of a polyenes drug?
Nystatin
93
Nystatin MOA?
bind to ergosterol leading to leakage of cell membrane.
94
What species is fluconazole active against?
Candida
95
Which bacteria are considered "atypicals"?
* mycoplasma pneumoniae * chlamydia pneumoniae * legionella pneumoniae
96
What class is used to treat atypical infections?
Macrolides.
97
What are the predominant organisms in AOM?
M. cattarhalis, S. pneumoniae, H. influenzae.
98
Rationale for high-dose amoxicillin in AOM?
overcome penicillin binding protein resistance of causitive organism.
99
AOM diagnostic criteria?
- acute (< 48H) onset of sxs - middle ear fluid - TM bulging OR acute perforation with purulent discharge
100
Criteria for watchful waiting for AOM?
- >6m - mild illness - present within 48H of onset of ear pain - have not had AOM in previous month + not recurrent - no cochlear implants or other hearing impairment - no hx of another condition that could make recovery more difficult
101
Standard amox dose for AOM? high dose?
Standard: 45-60 mg/kg/day divided TID High: 80-90 mg/kg/day divided BID or TID
102
Who should get high dose amox for AOM?
those suspected to have resistant S. pneumoniae or if failed standard dose.
103
Risk factors for resistant S. pneumoniae?
- < 2 yrs old - daycare (or family in daycare) - any abx exposure within 3 months - under-vaccinated or unvaccinated
104
Stopped making cards on short snappers slide 22.

PEBC Prep (61 decks)

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