Midterm Key Points Flashcards
Which 2 medications are only used for UTIs
Nitrofurantoin (macrobid)
Fosfomycin (Monurol)
Generally, what is metronidazole (flagyl) used for
“below the diaphragm” bacterial anaerobes (bacteriodes, Clostridium)
3 antibiotics with no oral absorption
fidaxomicin
vancomycin
rifaximin
what antibiotic is highly toxic and is the last resort drug for high resistant PEK and SPACE infections
polymixin/colistin
4 nephrotoxic antibiotics
vancomycin
colistin
aminoglycosides
Bactrim (crystalluria)
what antibiotics cover atypical bacteria
FQs
tetracyclines
macrolides
why is daptomycin not used for pneumonia
inactivated by lung surfactants
what antibiotic is associated with a high incidence of c.diff
clindamycin
what is clindamycin used for
gram positive cocci & oral anaerobes
-used as a topical for Gardenerella Vaginosis
S. Pneumo is building resistance to what antibiotic
Macrolides due to misuse in treating viral upper respiratory tract infections
-Also resistant Bactrim
what antibiotic has a high tissues absorption (loading dose req.), long half-life, and fights infection 1 wk after stop taking it
azithromycin
what 2 classes cause QT prolongation
macrolides and FQs
what 2 classes bind metals reducing absorption
FQs and tetracyclines
what antibiotic changes urine brown
nitrofurantoin
what antibiotic changes urine/tears red
rifamycins
what antibiotic turns feces red due to binding iron
cefdinir
what antibiotics are phototoxic and you should avoid use in children
FQs and tetracyclines
what antibiotics attain high tissue concentrations, poor blood concentration (not used for bacteremia)
Macrolides and tigecycline
What antibiotics are good for bacteremia because they are highly polar, attaining high blood concentrations but poor tissue concentration
aminoglycosides
t or f? less diarrhea for AMX than AMP due to more complete absorption;
true
what part of augmenting causes diarrhea
clavulanate
B-lactamase inhibitors with AMP/AMX gives coverage for
MSSA and B.fragilis
t or f? Because streptococci do not make B-lactamase, you can use Pen G/V and AMP/AMX
true
t or f? cephalosporins are not destroyed by Gram positive B-lactamase (only have penicillinases)
true
t or f? cephalosporins are sometimes destroyed by Gram negative B-lactamases
true
how do you overcome ESBL producing gram negative species that destroy all penicillins and cephalosporins
ESBL inhibitor avibactam
t or f? carbapenems are not destroyed by ESBL
true
how do you overcome carbapenemase KPC
carbapenemase inhibitor vaborbactam
How is MRSA resistant to B-lactam
due to destruction by penicillinase/cephalosporinase and non-binding to PBP2a
what is the only b-lactam that can bind PBP2a and work against MRSA
Ceftaroline
what is enterococcus resistant to
all cephalosporins and FQs
what is the preferred antibioitc for enterococcus
ampicillin
3 antibiotics that cover VRE
ampicillin
linezolid
daptomycin (cubicin)
what are options to cover MRSA
ceftaroline
glycopeptides/lipoglycopeptides
linezolid
cubicin
tetracyclines
what is used for CA-MRSA
TMP-SMX and clindamycin
What is used to cover MSSA to prevent resistance in other bacteria
narrow spectrum nafcillin and oxacillin
What antibiotics are options for SPACE
CIP/LVN
pip-tazo
ceftazidime
cefepime
carbapenems (except ertapenem)
aztreonam
colistin
aminoglycosides
what covers anaerobes except c.diff
MOX
pip-tazo
carbapenems
what are ADRs shared by all B-lactams
hypersensitivity/anaphylaxis
CDAD
seizures
what antibiotic interferes with bilirubin metabolism and causes biliary sludging
ceftriaxone (rocephin)
t or f? cefotaxime does not interfere with bilirubin metabolism and is less toxic in neonates than ceftriaxone
true
what antibiotics are CYP inducers of liver metabolism which may decrease blood levels of other drugs
rifamycins
what antibiotics are CYP substrates which may increase blood levels of other drugs
macrolides
t or f? probenecid increases blood levels of renal excreted drugs
true
t or f? most antibiotics are eliminated in urine
true
what antibiotics are primarily eliminated in the feces
moxifloxacin
nafcillin
macrolides
rifampin
clindamycin
what 3 antibiotics do you have to monitor serum levels because of nephrotoxicity
vancomycin
aminoglycosides
colistin
what antibiotics and mechanisms are bactericidal
cell wall inhibitors
lipopeptides
quiunolones
aminoglycosides
metronidazole
what antibiotics and mechanisms are bacteriostatic
folic acid inhibitors
most 30S/50S ribosome protein synthesis inhibitors except aminoglycosides
what skin microflora causes abscess (pus) furuncles (pus filled boil) carbuncles (cluster of boils) bullous impetigo/ecthyma and folliculitis
s. aureus
what are infections caused by GAS
impetigo/ecthyma, cellulitis, erysipelas, and necrotizing fasciitis (flesh eating bacteria)
what is a contagious SSSI cause of honey-colored crusted lesions around the mouth
impetigo
what bacteria cause human bite wound infections
eikenella and oral anaerobes
what bacteria cause animal bite wound infections
pasteurella and oral anaerobes
What bacteria may cause necrotizing fasciitis
GAS
Vibrio Vulnificus
Aeromonas
What bacteria may cause gangrene
clostridium perfringens
what bacteria cause burn wound infections
Gram positive cocci
Pseudomonas Aeruginosa
What bacteria causes “nail through shoe” infection and hot tub folliculitis
Pseudomonas
what bacteria may cause diabetic foot infections and bed sores
polymicrobial
Topical antibiotics
fusidic acid
mupirocin
retapamulin (MRSA)
what topical cream is used for burn wounds and is antipseudomonal
silver sulfadiazine
what are most bone and joint infections due to
skin microflora Gram Positive cocci (s.aureus most common)
t or f? large joint infections are more common than small joint infections
true
What are the two common bacterial causes of septic arthritis for IV drug abusers
S.aureus and Pseudomonas
What gene is common in Reiters arthritis
HLA-B27
what is the common bacterial cause of hardware associated arthritis
biofilm forming coagulase negative staph epidermidis
polyarthritis is most common in young adults due to
n. gonorrhoeae
What causes Reiters (reactive arthritis)
Campylobacter ad Chlamydia
what causes peritonitis
spillage of bowel into peritoneum
what bacteria cause intraabdominal infections
GI anaerobes like Bacteriodes, PEK (e.coli)
staph
strep
enterococcus
T or f? multiple pathogens are the cause of secondary peritonitis and often occurs in ruptured appendix
true
What patient profile is common for SBP
cirrhosis
what pathogen is most common in primary (spontaneous) peritonitis
e. coli
t or f? appendicitis is the most common etiology of intraabdominal infections
true
t or f? gastroenteritis (stomach flu) often results in infectious diarrhea due to an infectious agent
true
what bacteria causes most non-inflammatory diarrhea (travelers, watery)
e. coli (ETEC)
Vibrio Cholera causes what kind of diarrhea by eating raw shellfish from Gulf of Mexico
watery non-inflammatory diarrhea
Shigella causes what kind of diarrhea by fecal-oral transmission
watery (daycare diarrhea)
what is most inflammatory diarrhea due to
Campylobacter jejuni
what diarrhea is caused by Shiga Toxin E.coli O157:H7
inflammatory diarrhea
what causes typhoid fever
salmonella typhi
What antibiotics are used for diarrhea
FQs
azithromycin
rifaximin (e.coli only)
what is the primary treatment goal for infectious diarrhea
fluid and electrolyte replacement
what is common cause of viral GI infection in adults
Norovirus/Norwalk virus
what is common cause of viral GI infection in children due to fecal oral transmission
rotavirus that has a vaccine available for immunity
what is the cause of botulism and floppy baby syndrome after eating swollen cans/jars
Clostridium botulinum
what is CDAD
c.diff associated diarrhea obtained by patients in medical facilities transmitted via spores by healthcare workers
how to prevent CDAD
proper glove usage and avoiding antimotility agents like imodium
if CDAD is untreated what can it lead to
toxic megacolon and colon rupture that leads to peritonits
why is there high recurrence and relapse in C.diff
antibiotics do not work on c.diff spores
what covers c.diff
oral vancomycin and fidaxomicin because they are not absorbed
metronidazole (disulfiram reaction with alcohol)
what bacteria is cystitis and pyelonephritis usually due to
PEK (e.coli most common)
what is considered the honeymoon bug and causes UTIs in young women
s. saprophyticus
why are females more prone to UTIs
shorter urethra
t or f? males always have a complicated UTI and sometimes due to enlarged prostate
true
t or f? urinary catheter patients usually obtain UTI following catheterization
true
what is used in diagnosis of UTI
midstream (clean catch) urine culture, leukocyte esterase, nitrate positive test
what are 2 indicators of upper UTI (include pyelonephritis)
urinary casts
flank pain
what covers UTIs
Bactrim
nitrofurantoin (macrobid)
fosfomycin (monurol)
three most common pathogens for STIs
Chlamydia Trachomatis > Nesisseria gonorrhoeae > Trichomonas vaginalis
t or f? C. trachomatis causes asymptomatic or mild infections that often go untreated (higher incidence rates)
true
what can Chlamydia and Gonorrheae cause
Primarily: urethritis, cervicitis, PID
arthritis
conjunctivitis
pharyngitis
t or f? PID arises during menstruation when GU bacteria can ascend to uterus
true
What is trichomoniasis due to and the most common co infection with it
due to Trichomonas vaginalis (protozoa) and common co infection with gonorrhoeae
what causes bacterial vaginosis
Gardenerella vaginalis overgrowth that produces fishy odor after antibiotic use
what causes syphilis (genital ulcer disease)
Treponema pallidum (spirochete) obtained by sexual contact or mom to fetus (congenital)
how do you treat syphilis
slow release benzathine Pen G (IM only)
how can you prevent genital warts due to HPV
immunization with the HPV vaccine
what are DNA viruses that cause disease and remain in the body dormant (latent) form for life
human herpesviruses (HHV)
what can cause HHV infection to be reactivated (flare up)
stress or immune system suppression/deficiency
what is the only vaccine available for a HHV
Varicella-Zoster Virus vaccine
what causes mouth sores, genital ulcers, encephalitis, keratitis (corneal ulcers), hepatic whitlow (hand ulcers)
HSV
what can cause post-herpatic neuralgia (stabbing pain) and ophthalmic zoster (corneal ulcers)
VZV Zoster
what is the classic triad of epstein barr virus
splenomegaly
exudative pharyngitis
lymphadenopathy (swollen glands)
t or f? reactivated EBV can cause lymphoma in HIV patients
true
cytomegalovirus manifests mostly in immune deficient patients as what
retinitis or encephalitis
Kaposis Sarcoma manifests mostly in immune system suppression/deficient patients as what
skin cancer (tumors)
most HHV antivirals are nucleoside analogs that do what
inhibit viral DNA polymerase
what 3 drugs are activated by
phosphorylation by HHV thymidine kinase inside infected host cell
acyclovir (ester prodrug = valacyclovir), penciclovir (famciclovir), and ganciclovir (valganciclovir)
what prodrugs (preferred) are used to increase oral absorption and what are they metabolized by
ester prodrugs metabolized by serum esterase
primary manifestation and transmission of HHV1/HSV1
herpes labialis (cold sores) transmitted through saliva and sore contact
primary manifestation and transmission of HHV2/HSV2
genital herpes (ulcers) transmitted through sexual contact
primary manifestation and transmission of HHV3/VZV
chicken pox (varicella)
shingles (zoster)
transmitted through respiratory secretions
primary manifestation and transmission of HHV4/EBV
mononucleosis and lymphoma transmitted through respiratory secretions
primary manifestation and transmission of HHV5/CMV
retinitis, encephalitis transmitted through bodily secretions
primary manifestation and transmission of HHV6-7/CMV
roseola transmitted by respiratory secretions
primary manifestation and transmission of HHV8/KSHV
Kaposis sarcoma (tumors) transmitted through bodily secretions
3 most common pathogens causing meningitis
s. pneumo > n. meningitidis > H. flu
what are classical signs of meningitis
fever
neck stiffness (nuchal rigidity)
headache
altered mental status
what suggests meningitis due to n. meningitidis vs s. pneumo
skin lesions (purpura) suggests n. meningitidis and respiratory co-infection suggests s. pneumo
t or f? s. pneumo does not possess B-lactamase so you can use penicillins without a B-lactamse inhibitor
true
t or f? n. meningitidis and H. flu often have B-lactamase which is susceptible to ceftriaxone (adults) and cefotaxime (neonates)
true
why is ceftriaxone and cefotaxime used in meningitis
because they have good CSF penetration
why is dexamethasone used in meningitis
lower CNS inflammation
what causes Bells palsy
HSV
encephalitis is usually due to what viruses
HSV > VZV > CMV > west nile
Most URTIs are due to viruses and transmitted by
respiratory aerosols
what is the primary cause of rhinitis, colds, and pharyngitis
rhinovirus
signs in influenza virus
dry cough, fever, risk of bacterial pneumonia
signs in parainfluenza virus
croup, stridor in infants
signs of cold
productive cough, mild to no fever
antivirals used for the flu
neuraminidase inhibitors:
-zanamivir (Relenza, dry powder inhaled, bronchospasm problems)
-oseltamivir (Tamiflu, oral)
how many strands does the flu vaccine cover and why does it require annual updates
2 A and 2 B strands and requires updates due to H antigen mutation (antigenic drift)
otitis media (middle ear) is due to secondary bacterial infections by what 3 pathogens
s. pneumo
M. cat
H. flu
why are children more prone to ear infections
because of their shorter eustachian tube
t or f? rhinosinusitis is usually due to virus
true
what causes epiglottitis and how to prevent it
H. flu and vaccine can help to prevent it
what is epiglottitis and how to tell on an x-ray
inflammation of the epiglottis that can block the trachea
looks like a thumbs up on an x-ray
complications of strep throat caused by s.pyogenes
scarlet fever and rheumatic fever
streptococcus is often resistant to what antibiotics
macrolides
tetracyclines
cipro
bactrim
pathogens that cause bronchitis
respiratory viruses > mycoplasma pneumoniae
pathogens of chronic bronchitis
viruses
H.flu in smokers and patients with COPD
cause and treatment/prophylaxis of bronchiolitis
Caused by RSV
treat with inhaled ribavirin (monitor for hemolytic anemia)
Prophylaxis with monoclonal antibody Palivizumab (synagis)
pathogens causing community acquired pneumonia
S. pneumoniae > H.flu
timeline for community acquired pneumoniae
< 48 hours after admission
timeline for healthcare associated pneumonia
obtained in healthcare setting < 48 hours after admission
Timeline difference for early and late onset hospital acquired pneumonia
early onset: >/= 48 hours after admission
late onset: >/= 120 hours after admission
timeline for ventilator acquired pneumonia
> /= 48 hours after intubation
what is typical pneumonia caused by
gram positive and gram negative bacteria
what is atypical pneumonia caused by
atypical bacteria (chlamydophila, legionella, mycoplasma)
viruses
fungi
what bacteria that cause respiratory tract infections is covered by macrolides
H. flu and M. cat
what are the respiratory FQs
levofloxacin and moxifloxacin
t or f? respiratory FQs cover atypical and most typical pneumonias (s. pneumo is CIP resistant)
true
t or f? h. flu and M. cat susceptible to augmentin and 2-3 gen cephalosporins
true
what pathogens are most causes of infective endocarditits
staphylococci > streptococci (viridans)
t or f? highest infective endocarditis is in prosthetic valve (PVE) and IV drug abusers (MRSA and Pseudomonas)
true
how does vegetation occur
bacteremic bacteria colonize cardiac lesion
what is a hallmark of infective endocarditis
vegetation that results in continuous bacteremia
t or f? vegetation can result in the release of septic emboli that can deposit in organs
true
what are 4 signs of infective endocarditis
Janeway lesions, Roth spots, murmurs, and splinter hemorrhages
what are some anti staphylococcal penicillins that cover staph/MSSA
oxacillin
nafcillin
oral dicloxacillin
what can be added to treatments to cover biofilms
rifampin
3 classical signs of sepsis
fever
chills
hypotension
what is SIRS
systemic inflammatory response syndrome
2 or more signs/symptoms out of abnormal WBC/HR/RR/BT
t or f? sepsis = SIRS + bacteremia (positive blood culture)
true
t or f? sepsis most commonly arises from respiratory infections
true
what are 5 complications of sepsis
- septic shock
- disseminated intravascular coagulation (DIC)
- acute respiratory distress syndrome (ARDS)
- low systemic vascular resistance (SVR)
- acute renal failure (ARF)
what happens in septic shock
inadequate oxygen in tissue (hypoxia)
what is disseminated intravascular coagulation (DIC)
impaired blood clotting leads to internal bleeding
what is acute respiratory distress syndrome (ARDS)
impaired blood oxygenation leads to ischemia
what is low systemic vascular resistance (SVR)
hypotension leads to ischemia
what is acute renal failure (ARF)
kidney injury leads to fluid accumulation
what medication is the gold standard for TB
rifampin
