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Introduction to Antimicrobials > Introduction to antimicrobials - CHEAT SHEET Cards > Flashcards

Introduction to antimicrobials - CHEAT SHEET Cards Flashcards

1
Q

What are the 8 habits of highly effective antimicrobial stewardship programs?

A
  1. LEADERS ESTABLISH ANTIMICROBIAL STEWARDSHIP AS AN ORGANIZATIONAL PRIORITY
  2. HOSPITALS EDUCATE STAFF AND LICENSED INDEPENDENT PRACTITIONERS INVOLVED IN ANTIMICROBIAL ORDERING, DISPENSING, ADMINISTRATION, AND MONITORING ABOUT ANTIMICROBIAL RESISTANCE AND ANTIMICROBIAL STEWARDSHIP PRACTICE
  3. HOSPITALS EDUCATE PATIENTS AND FAMILIES REGARDING THE APPROPRIATE USE OF ANTIMICROBIAL MEDICATIONS
  4. THE HOSPITAL HAS AN ANTIMICROBIAL STEWARDSHIP MULTIDISCIPLINARY TEAM
  5. THE HOSPITAL’S ASP INCLUDES THE 7 CORE ELEMENTS OF HOSPITAL ASPS FROM THE CDC
  6. THE HOSPITAL’S ASP USES ORGANIZATIONAL-APPROVED MULTIDISCIPLINARY PROTOCOLS
  7. THE HOSPITAL COLLECTS, ANALYZES, AND REPORTS DATA ON ITS ASP
  8. HOSPITALS TAKE ACTION ON IMPROVEMENT OPPORTUNITIES IDENTIFIED IN ITS ASP
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2
Q

What are the 4 “loose” classifications of bacteria? (from the cheat sheet document)

A

Gram +ve, gram -Ve, aerobic and atypical

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3
Q

How to Beta lactams work?

A

They inhibit bacterial cell wall synthesis

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4
Q

What is a major SE of beta lactams?

A

Allergic reactions. If anaphylactic best to avoid unless there is no choice.

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5
Q

What are the two most common mechanism of resistance for beta-lactam ABs?

A
  1. Beta-lactamase production
  2. Alteration of penicillin-binding proteins.
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6
Q

Describe Pen G and Pen V:
1. What do they cover?
2. What about resistance to it?

A
  1. Covers streptococcus, and some enterococcus. Limited Gram -Ve (pen G and Pen V - Very narrow spectrum)
  2. It was over used and resistance occurred quickly
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7
Q

What does cloxacillin cover?

A
  1. Covers Strep and MSSA
    (No other gram +ve and no gram -ve
  2. covers staph (not epi) and strep well (Pneumo and pyogenes)
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8
Q

Ampicillin and Amoxicillin coverage?

A

Narrow Spectrum
1. Covers Strep but NOT MSSA
2. Listeria
3. Similar Enterococcus coverage as Pen

Limited gram -ve that includes H. Influenza and P. Mirabellus

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9
Q

Describe Amox/Clav Coverage?

A

MODERATE BROAD spectrum
1. Addition of Clavulanate increases coverage against gram +ves, including MSSA, gram -ves like H. Influenza (If beta-lactamase producing), M. Catarrhalis, E.coli, Klebs spp. salmonella and shigella and anaerobes, B. frag

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10
Q

Piperacilin/Tazobactam coverage?

A

BROAD SPECTRUM
1. MOST COMPREHENSIVE coverage due to binding to MORE penicillin binding proteins.
2. Covers Strepp, MSSA (Need Tazobactam to cover it though), gram -Ve beta-lactamase producers (especially E.coli), pseudomonas (the first to), and B. Frag Coverage

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11
Q

How many generations of cephalosporins are there?

What do these agents NOT cover?

A

5
in general, as you move up the generations, the gram -ve coverage increases

No Enterococcal coverage

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12
Q

List 3 FIRST generation cephalosporins? What is their coverage?

A
  1. Cefadroxil, cephalexin, cefazolin
  2. Similar MSSA and Strep coverage as Clox but also covers P. Mirabilis, E.Coli, Klebsiella Spp. (PEK)
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13
Q

List 4 SECOND Generation cephalosporins.
What is their coverage?

A
  1. Cefuroxime, cefaclor, cefprozil, cefoxitin
  2. Similar MSSA and strep coverage as Clox but also covers H. Influenza P. Mirabilis, E. Coli, Klebsiella spp. (Klebs)
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14
Q

What do second generation cephalosporins cover that first generations not?

A
  1. H. Influenza!!!
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15
Q

List 4 THIRD Generation cephalosporins and their coverage.

A
  1. Cefixime, Cefotaxime, Ceftriaxone, Ceftazidime
  2. Similar MSSA and strep coverage as clox (Not cefixime or Ceftaz though). Very good Gram -ve coverage, INCLUDING pseudomonas
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16
Q

What is a bacteria type that the 3rd gen cephalosporin ceftaz cover, that lower generations do not?

A

Pseudomonas

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17
Q

Describe the coverage of carbapenems? (Also inhibit bacterial cell wall synthesis)

A

These pretty much cover most things including :
- Strep,
- MSSA
- Gram -ve including pseudomonas (except ertapenem
- and B. Frag

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18
Q

List the three macrolides

A
  1. Clarithromycin, azithromycin and erythromycin
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19
Q

How do macrolides work?

A
  1. They act intracellularly by binding to the 50S ribosomal subunit inhibiting protein synthesis
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20
Q

What is the major mechanism of resistance with macrolide ABs?

A

Active efflux of the drug from the bacteria.

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21
Q

What is the most common side effect from macrolide?

A
  1. Stomach upset
  2. Taste disturbances,
  3. QT prolongation
    DRUG INTERACTIONS with clarithromycin.
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22
Q

Describe the coverage of clarithromycin and azithromycin?

A
  1. Not great gram Gram +ve coverage (mostly strep spp and somewhat with MSSA)
  2. Covers most gram -ves of concern in respiration infections (H. INflu, M. Catarrhalis) and will cover atypicals (chlamydophila pneumoniae, mycoplasma pneumoniae).
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23
Q

What is the only thing that erythromycin has in common with azithromycin and clarithromycin?

A

Atypical coverage.

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24
Q

Which of the 3 macrolides can cause taste disturbances?

A

Clarithromycin

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25
Q

List the three tetracycline antibiotics

A

Tetracycline, minocycline and doxycycline

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26
Q

How do tetracycline AB work?

A
  1. They act intracellularly by binding to the 30S ribosomal subunit inhibiting protein synthesis
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27
Q

What are the major mechanisms of resistance for tetracycline AB?

A

Efflux of the drug from the bacteria

28
Q

What are most common adverse effects from tetracycline ABs?

A
  1. GI upset (worse with doxy, esophageal ulceration)
  2. photosensitivity
  3. Contraindicated in kids <8 (Ruins teeth)
  4. can Bind to Divalent cations (ca, Mg, Al)
29
Q

What is the coverage of Doxy and minocycline?

A

Covers:
1. Staph (MRSA and MSSA) and Strep pneumonia.
2. Covers most gram -ves for respiratory infections (H.Influ, M. Catarrhalis) and can cover atypicals 9Chlamydophila pneumoniae, mycoplasma pneumoniae)

30
Q

How are macrolides and tetracyclines similar

A
  1. Mostly used in resp infection, but sometimes in skin and soft tissue infections
31
Q

What are the 4 quinolone ABs?

A
  1. Ciprofloxacin, Norfloxacin, levofloxacin and moxifloxacin
32
Q

How do Quinolones work?

A
  1. They act intracellularly by inhibiting topoisomerase (DNA gyrase) I and IV.
33
Q

What is the major mechanism of resistance for quinolones

A
  1. Alteration of binding to the toperisomerase I and IV
34
Q

What are the most common side effects with quinolones?

A
  1. QT prolongation
  2. Photosensitivity
  3. Binds to divalent cations,
  4. Can affect sugars
  5. Can cause drowsiness, confusion, seizures
35
Q

What organ do quinolones penetrate well into?

A

LUNGS!

36
Q

What is the coverage like for quinolone ABs?

A
  1. OPPOSITE of Betalactams! Start with gram -ve (Cipro), and move to more gram +ve (levo and moxi)

Cipro has very POOR gram +ve coverage.
Cipro is primarily gram -Ve in particular pseudomonas.

Cipro also has some atypical coverage (Mycoplasma)

37
Q

Describe the coverage of Levo and Moxi?

A
  1. GRAM +Ve (MSSA and Strep). Similar coverage to Cipro for gram -ve and atypicals (only levo will cover pseudomonas at high doses)
38
Q

What are the two aminoglycosides?

A

Gentamycin and tobramycin

39
Q

How do aminoglycosides work?

A
  1. They act intracellularly by binding to 30S subunit and cause defective cell membrane and death.
40
Q

What are the most common side effects of aminoglycosides?

A

Nephrotoxicity, ototoxicity

41
Q

What do Aminoglycosides cover?

A
  1. ONLY gram -Ve including pseudomonas
42
Q

How does vancomycin work?

A

Cell wall inhibitor

43
Q

What are major side effects of vancomycin?

A
  1. Infusion reactions, nephrotoxicity (worse when used with an aminoglycoside), and ototoxicity
44
Q

What kind of coverage does vancomycin have?

A
  1. Covers all gram +ves very well including MRSA and both species of enterococcus.
  2. NO gram -ve coverage or anaerobes
45
Q

When should vancomycin be used?

A

Use should be restricted to MRSA, true beta-lactam allergy, or other MSSA AB intolerance

46
Q

How does clindamycin work?

A
  1. Binds to the 50S ribosomal units
47
Q

What are two major side effects of clindamycin?

A
  1. Diarrhea
  2. C.Diff
48
Q

What is the coverage like for clindamycin?

A
  1. Covers most gram positives (MSSA and MRSA and strep species).
  2. Covers anaerobes like B. frag
  3. No gram -ve coverage

Often used for folks with true beta-lactam allergy.

49
Q

How does Septra work?

A
  1. They work synergistically to affect dihydrofolate production causing cell death
50
Q

What are the most common side effects of septra?

A
  1. Skin rashes
  2. GI upset
  3. Possible increases in serum cr and K
  4. Best avoided in pregnancy
51
Q

What kind of coverage does septra have?

A
  1. MRSA and MSSA
  2. Reasonable gram -ve coverage with E.coli, H. Influ, M. Catarrhalis
52
Q

What does metronidazole cover?

A
  1. Anaerobes
53
Q

What kind of side effects does metronidazole have?

A
  1. Neuropathies with long term use
  2. Bad taste
54
Q

Which antibiotics cover Strep Spp?

A
  1. Any betalactam (Except Cetaz)
  2. Macrolides and tetracyclines
  3. vanco
  4. Clindamycin
  5. quinolones (EXCEPT CIPRO)
55
Q

What antibiotics cover MSSA?

A
  1. Cloxacillin
  2. Cephalexin
  3. Cefazolin
  4. Vanco/clinda could be used if nothing else
56
Q

Which antibiotics have Polymicrobial coverage (including anaerobes)

A
  1. Amox/clav
  2. Pip/Taz
  3. Carbapenems
57
Q

Which antibiotics have polymicrobial coverage (excluding anaerobes)

A
  1. 3rd Gen cephalosporins
58
Q

Which antibiotics can cover respiratory type pathogens (not including atypicals)

A

Amox/clav, 2nd/3rd gen cephs

59
Q

Which antibiotics can cover Respiratory type pathogens (INCLUDING ATYPICALS)

A
  1. Macrolides
  2. Tetracyclines,
  3. Quinolones
60
Q

Which antibiotics have good gram -ve coverage?

A
  1. Pip/Taz
  2. Carbapenems, 3rd gen cephs, Aminogylcosides, quinolones
61
Q

Which antibiotics have good pseudomonas coverage?

A
  1. Pip/Tazo
  2. Imipenem
  3. Meropenem
  4. Ceftazidime
  5. Cipro
  6. High dose levofloxacin
62
Q

Which antibiotics cover B.Frag

A
  1. Amox/clav
  2. Pip-Taz
  3. Carbapenems
  4. Clindamycin
  5. Metronidazole
63
Q

Which antibiotics cover atypicals?

A
  1. Macrolides
  2. Tetracyclines
  3. Quinolones
64
Q

Which antibiotics have similar side effects:
a. GI
b. Photosensitivity
c. QT prolongation
d. Binds to cations
e. Nephrotoxicity
f. Taste disturbances

A

a. GI - All
b. Photosensitivity - Tetracyclines, and quinolones
c. QT prolongation - Macrolides and quinolones
d. Binds to cations - Tetracyclines and quinolones
e. Nephrotoxicity - Aminoglycosides and vanco
f. Taste disturbances - Macrolides and metronidazole

65
Q

Which antibiotics inhibit cell wall synthesis?

A
  1. Beta-lactams
  2. Vancomycin
66
Q

Which act on ribosomes

A
  1. Macrolides
  2. Tetracyclines
  3. Clindamycine
  4. Aminoglycosides
67
Q

Which antibiotics affect DNA?

A

Quinolones

Introduction to Antimicrobials (10 decks)

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