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CDM 3 Exam 1 > Lecture 1 - Clinical application of Abx and AST > Flashcards

Lecture 1 - Clinical application of Abx and AST Flashcards

1
Q

If Maculopapular rash then…

A
  1. avoid original drug
  2. Ok to use from different class of Beta-lactam

Ex. Rash with penicillin, avoid penicillin but OK to use cephalosporin

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2
Q

If get hives then….

A

Avoid all beta-lactams except aztreonam

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3
Q

If get anaphylaxis then…

A

avoid all beta lactase

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4
Q

If unspecified rash then….

A

assume the worst (ie hives) so avoid all except aztreonam

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5
Q

Maculopapular rash info

A
  1. Generally less severe, often not true drug allergy
  2. Symmetrical ruby red rash
  3. typically can use beta lactams not of the class associated with the rash
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6
Q

Uricarial Rash & Hives info

A

1.Generally more severe, associated w/ true allergy
2. Asymmetrical w/ darker borders + lighter centers
3. Cross reactivity rates can vary
4. Avoid other beta lactams except Aztreonam**

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7
Q

Anaphylaxis info

A
  1. severe/life threatening
  2. avoid all betalactams
  3. For true allergy, if pt needs, can be desensitized using graded dosing under close supervision**
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8
Q

Antibiotic Stewardship benefits

A
  1. can increase infection cure rates, while reducing….

Txm failure, Cdif infection, ADE, Abx resistance, Hospital costs + length of stay

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9
Q

Core elements of Hospital Abx Stewardship programs

A
  1. hospital leadership commitment
  2. accountability
  3. Pharmacy expertise
  4. action
  5. Tracking
  6. Reporting
  7. Education
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10
Q

Gram + Penicillin coverage

A

E.faecalis
Strep (Group A/B, Pneumoniae)

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11
Q

Gram - Penicillin coverage

A

Neisseria meningitidis

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12
Q

Anaerobes Penicillin coverage

A

Actinomyces
Clostridium spp
Peptostreptococci
Propionibacterium

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13
Q

Other Penicillin coverage

A

Treponema pallidum (Spirochete)
Leptospira spp (Spirochete)

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14
Q

Penicillin Clinical uses

A

Neurospychillis (T. pallidum)
Pharyngitis (Grp A Strep)
Pneumonia (PCN-S, S.pneumoniae)
Endocarditis (PCN-S strep)
Cellulitis (Grp A/B)

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15
Q

Aminopenicllin drugs

A

Ampicillin and Amoxicillin

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16
Q

Gram + Ampi/Amox coverage

A

E. Faecalis
Strep (Grp A/B, Pneumoniae)
Listeria monocytogenes

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17
Q

Gram - Ampi/Amox coverage

A

N. Meningitidis
H. Influenzae

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18
Q

Anaerobes Ampi/Amox coverage

A

Actinomyces
Clostridium spp
Peptostreptococci
Propionibacterium

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19
Q

Other Ampi/Amox coverage

A

Leptospirra spp (Spirochete)

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20
Q

Ampi/Amox Clinical uses

A

Meningitis (Amp; Listeria)

Endocarditis (Amp: E.faecalis)

Pneumonia, Sinusitis, Oropharyngeal infection, Otitis media (B-lactamase negative H.influ)

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21
Q

Penicillinase-Resistant Penicillins

A

Nafcillin + Oxacillin

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22
Q

Nafcillin & Oxacillin Gram + coverage

A

Strep spp. (Grp A/B, Pneumoniae)

** S. Aureus (MSSA)*

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23
Q

Nafcillin & Oxacillin Clinical uses

A

Meningitis (MSSA)
Endocarditis (MSSA)

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24
Q

Vancomycin Gram + Coverage

A

Strep spp (Grp A/B, Pneumoniae)
S. aureus (MSSA + MRSA)
E. Faecalis

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25
Q

Daptomycin/Linezolid Gram + coverage

A

Strep spp (Grp A/B, Pneumoniae)
S. aureus (MSSA + MRSA)
E. Faecalis
VRE ***

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26
Q

Anaerobes coverage Vancomycin/ Daptomycin

A

P.acnes
Peptostreptococci

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27
Q

Anaerobes coverage Linezolid

A

Clostridium Bacteroides**
P.acnes
Peptostreptococci

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28
Q

Clinical uses Vancomycin

A

Meningitis ( S.pneumoniae, MRSA)
HAP/VAP (MRSA)
Bacteremia (MRSA)

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29
Q

Clinical uses Daptomycin

A

Bacteremia (VRE)
UTI (VRE)
Intra-abdominal infection (VRE)
Bacteremia (MRSA)

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30
Q

Clinical uses Linezolid

A

HAP/VAP (MRSA)
UTI (VRE)
Intrabdominal infections (VRE)
Bacteremia (MRSA)

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31
Q

B-lactam/B-lactam inhib combos

A

Ampicillin/Sulbactam
Amoxicillin/Clav

Piperacillin/Tazobactam

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32
Q

Ampicillin/Sulbactam & Amoxicillin/Clav Clinical uses

A

UTI (E.coli susceptible)
HAP/VAP (Acinetobacter; Amp/Sulb only**)
SSTI (Mixed Gram +/- susceptible, anaerobes)
Pneumonia/Sinusitis/Otitis media (B-lact + H.influ)

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33
Q

Ampicillin/Sulbactam & Amoxicillin/Clav Gram + coverage

A

E.Faecalis
Strep spp. (Grp A/B, pneumoniae)
S. aureus (MSSA)

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34
Q

Ampicillin/Sulbactam & Amoxicillin/Clav Gram - coverage

A

E.coli; Proteus mirabilis
H.Influ; M.catarrhalis
Acinetobacter (Amp/sulb)***

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35
Q

Ampicillin/Sulbactam & Amoxicillin/Clav Anaerobes coverage

A

Actinomcyes
Clostridium
Peptostreptococci
Propionibacterium
B.fragilis
F.necrophorum

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36
Q

Piperacillin/Tazobactam has added coverage for what gram -

A

Pseudomonas

37
Q

Piperacillin/Tazobactam Clinical uses

A

HAP/VAP (P.aeruginosa)
UTI (E.coli, Proteus, Klebsiella, Pseudomonas)
SSTI (mix gram - / gram +, pseudomonas, anaerobes)
Intra-abd infection ( Enterobacter, Pseudomonas)

38
Q

1st gen Cephalosporins

A

Cefazolin**
Cefadroxil
Cephalexin

39
Q

Cefazolin Clinical uses

A

Endocarditis (MSSA)
UTI (MSSA, E.Coli, Proteus)
Cellulitis (Grp A/B, MSSA)

40
Q

1st gen Cephalosporins Gram + coverage

A

Strep spp. (Grp A/B, pneumoniae)
S. aureus (MSSA)

41
Q

1st gen Cephalosporins Gram - coverage

A

E. coli
Proteus mirabilis
K.pneumoniae

42
Q

1st gen Cephalosporins Anaerobe coverage

A

P.acnes
Peptostreptococci

43
Q

2nd Gen Cephalosporins

A

Cefuroxime
Cefprozil
Cefaclor

44
Q

2nd Gen Cephalosporins Gram + coverage

A

Strep spp. (Grp A/B, pneumoniae)
S. aureus (MSSA)

45
Q

2nd Gen Cephalosporins Gram - coverage

A

E.coli
P.mirabilis
K.pneumoniae
H.infl
M.catarrhalis

46
Q

2nd Gen Cephalosporins Anaerobes

A

P. acnes
Peptostreptococci

47
Q

Cefuroxime Clinical uses

A

Pneumonia/Sinusitis/Otitis media (MSSA, S.pneumoniae, H.influ)

UTI (E.coli, Proteus)

48
Q

3rd gen Cephalosporins

A

Ceftriaxone + Cefotaxime

Ceftazidime

49
Q

3rd gen Cephalosporins Gram + coverage

A

Strep. spp (Grp A/B, Pneumoniae)
S.aureus (MSSA)** but not Ceftazidime

50
Q

3rd gen Cephalosporins Gram - coverage

A

E.coli
P. mirabilis
K.pneumoniae
H.influ
M.catarrhalis
Pseudomonas
Serratia
Enterobacter
Stenotrophomonas = ceftazidime only***

51
Q

3rd gen Cephalosporins Anaerobes coverage

A

P.acnes
Peptostreptococci

52
Q

How does Ceftazidime differ from other 3rd gen?

A

Covers Stenotrophomonas but doesn’t cover MSSA

53
Q

Ceftriaxone Clinical uses

A

Meningitis (S.pneuomoniae)
HAP/VAP ( S.pneuomoniae, Enterobacteriaceae)
UTI ( E.coli, Proteus, Klebsiella)
Intra-abd infection (Enterobacteriaeae, Pseudomonas)
Bacteremia (Enterobacteriaceae)

54
Q

Ceftazidime Clinical uses

A

HAP/VAP (Pseudomonas, Stenotrophomonas)
UTI ( E.coli, Proteus, Klebsiella)
Intra-abd infection (Enterobacteriaeae, Pseudomonas)

55
Q

Cefotaxime uses

A

Bacteremia (Enterobacteriaceae)
UTI ( E.coli, Proteus, Klebsiella)
Intra-abd infection (Enterobacteriaeae, Pseudomonas)

56
Q

4th Gen cephalosporin

57
Q

Cefepime Gram + coverage

A

Strep. spp (Grp A/B, pneumoniae)
S. aureus (MSSA)

58
Q

Cefepime Gram - coverage

A

E. coli
P.mirabilis
K. pneumoniae
H.influ
M.catarrhalis
Pseudomonas
Serratia
Enterobacter
Citrobacter

59
Q

Cefepime Anaerobic coverage

A

P.acnes
Peptostreptococci

60
Q

Clinical uses Cefepime

A

Meningitis (P.aeruginosa)
Bacteremia (MSPACE, Pseudomonas)
HAP/VAP (MSPACE, Pseudomonas)
UTI (MSPACE, Pseudomonas)
Intra-abd infections (MSPACE, Pseudomonas)

61
Q

5th gen Cephalosporin

A

Ceftaroline

62
Q

Ceftaroline Gram + coverage

A

Strep spp. (All species)
S. aureus (MSSA + MRSA)***

63
Q

Ceftaroline Gram - coverage

A

E.coli
P.mirabilis
K.pneumoniae
H.influ
M.catarrhalis

64
Q

Ceftaroline Anaerobes coverage

A

P.acnes
Peptostreptococci

65
Q

Clinical uses Ceftaroline

A

Bacteremia (MRSA, combo therapy)
Pneumonia (MRSA)
SSTI (Mixed MRSA + enterobacteriaceae)

66
Q

New Cephalosporins

A

Ceftazidime/Avibactam
Ceftolozane/Tazobactam
Cefiderocol

67
Q

New Cephalosporins Gram + coverage

68
Q

New Cephalosporins Gram - coverage

A

E.coli
P.mirabilis
K.pneumoniae - inc MDRO
H.influ
M.catarrhalis
Pseudomonas
Acinetobacter
Stenotrophomonas (Cefiderocol)** - inc MDRO

69
Q

New Cephalosporin Anaerobe coverage

A

P.acnes
Peptostreptococci (Except Cefiderocol*)
B.Frag (Ceftolozaone/tazo only)

70
Q

New Cephalosporin Clinical uses

A

HAP/VAP (MDR Gram -)
UTI (MDR Gram -)
Intra-adb infection (MDR Gram -)
Bacteremia ( MDR Gram -)

71
Q

Aztreonam Gram - coverage

A

E.coli
P.Mirabilis
K.Pneumoniae
H. influ
M.catarrhalis
Pseudomonas
Serratia
Enterobacter
Citrobacter

72
Q

Aztreonam Clinical uses

A

Penicillin Allergy

Ventriculitis or Meningitis ( Enterobacteriaceae or P.aerug)
HAP/VAP (MDR or P.aeruginosa)
UTI (MDR or Pseudomonas)
Intra-abd infect (MDR or Pseudomonas) + metronidazole +/- vanco

73
Q

Carbapenems Gram + coverage

A

Streptococcus spp. (Grp A/B, pneumoniae)
Staphylococcus aureus (MSSA)
Enterococcus faecalis (except ertapenem*)

74
Q

Carbapenem Gram - coverage

A

E. coli; Proteus mirabilis; K. pneumoniae – including ESBL*
H. influenzae; M. catarrhalis
Serratia; Enterobacter; Citrobacter
Pseudomonas (except ertapenem*)

75
Q

Carbapenem Anaerobe coverage

A

P.acnes
Peptostreptococci

76
Q

Carbapenem Clinical uses

A

Meningitis (ESBL, MSPACE, P.aeruginosa)** except -ertapenem

HAP/VAP (ESBL, MSPACE,P. aeruginosa)
UTI (ESBL, MSPACE, P.aeruginosa) Kidney only***
Intra-abd infection (ESBL, MSPACE, Pseudomonas
Bacteremia (ESBL, MSPACE, Pseudomonas)

77
Q

Fluoroquinolones

A

Cipro
Levo
Moxi
Dela

78
Q

Delafloxacin Gram + coverage

A

Strep spp (Grp A/B, pneumoniae)
S.aureus MSSA/MRSA
E.faecalis

79
Q

Delafloxacin/Levo/Cipro Gram - coverage

A

E. coli; Proteus mirabilis; K. pneumoniae
H. influenzae; M. catarrhalis
Serratia; Enterobacter; Citrobacter
Pseudomonas

80
Q

Which Gram - does Moxifloxacin not cover?

A

Pseudomonas

81
Q

Anaerobes coverage Delafloxacin

A

B.frag
P.acnes
Peptrostreptococci

82
Q

Fluoroquinolone w/ best Anaerobe coverage

A

Moxifloxacin

83
Q

Fluoroquinolone coverage for “other” bugs?

A

Mycobacteria = TB
Atypical

84
Q

Clinical uses Fluoroquinolones

A

Oropharyngeal (Moxi)

CAP (s.pneu + H.influ) all except cipro

UTI (enterobacteriaceae) all except moxi

Intra-ab infection (Enterobacteriaceae, Pseudomonas) all except moxi

Osteomyelitis

85
Q

Clinical uses Tetracyclines

A

HAP/VAP (MDr Acinetobacter) all except doxy
SSTI (MRSA) - doxy
Intra-ab infection (mixed Gram +/-)

86
Q

Azithromycin Gram + coverage

A

Strep spp. (Grp A/B, strep pneumoniae)

87
Q

Azithromycin Gram - coverage

A

H. influenzae

88
Q

“Other” coverage w/ Azithromycin

89
Q

Azithromycin Clinical uses

A

STDs (Chlamydia)
CAP (Atypical, combo w/ B-lactam)
Sinusitis, Bronchitis (susceptible S.pneu/H.influ)

CDM 3 Exam 1 (10 decks)

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