MTB Flashcards

1
Q

Penicillin (G,VK, benzathine)

A

viridans group streptococci, streptococcus pyogenes, oral anaerobes, syphilis, leptospira

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2
Q

Ampicillin and amoxicillin

A

cover the same organisms as penicillin, as well as E. coli, Lyme disease, and a few other gram-negative bacilli

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3
Q

Bacterial covered by amoxicillin (HELP)

A

H. influenzae, e. coli, Listeria, Proteus, and Salmonella

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4
Q

Amoxicillin “best initial therapy” for

A

Otitis media, dental infection and endocarditis prophylaxis, lyme disease limited to rash, joint, or seventh cranial nerve involvement, UTI in pregnant women, Listeria monocytogenes, Enterococcal infections

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5
Q

Penicillinase-resistant penicillins (PRPs) (oxacillin, cloxacillin, dicloxacillin, and nafcillin used to treat

A
Skin infections (cellulitis, impetigo, erysipelas)
Endocarditis, meningitis, and bacteremia from staphylococci
Osteomyelitis and septic arthritis only when the organism is proven sensitive
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6
Q

Piperacillin, ticarcillin, azlocillin, mezlocillin

A

These agents cover gram-negative bacilli (e.g., E. coli, Proteus) from the large enterobacteriaciae group as well pseudomonads. “Best initial therapy” for:
Cholecystitis and ascending cholangitis
Pyelonephritis
Bacteremia
Hospital-acquired and ventilator-associated pnemonia
Neutropenia and fever

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7
Q

Cephalosporins

A

The amount of cross-reaction between penicillin and cephalosporins is very small (

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8
Q

First Generation Ceph (Cefazolin, Cephalexin, Cephadrine, Cefadroxyl) used to treat

A

Staphylococci: methicillin sensitive = oxacillin sensitive = cephalosporin
Streptococci (except Enterococcus)
Some gram-negative bacilli such as E. coli, but not Pseudomonas
Osteomyelitis, septic arthritis, endocarditis, cellulitis

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9
Q

Second Gen Ceph (Cefotetan, Cefoxitin, Cefaclor, Cefprozil, Cefuroxime, Loracarbef)

A

Cefotetan or cefoxitin: Best initial therapy for pelvic inflammatory disease (PID) combined with doxycycline. Warning: Cefotetan and cefoxitin incrase the risk of bleeding and give a disulfiramlike reaction with alcohol
Cefuroxime, loracarbef, cefprozil, cefaclor: Respiratory infections such as bronchitis, otitis media, and sinusitis

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10
Q

Third Gen Ceph (Ceftrizxone, Cefotaxime, Ceftazidime)

A

Ceftriaxone: First-line for pnemococcus, including partially insensitive organisms (Meningitis, Community-acquired pneumonia (in combo with macrolides), Gonorrhea, Lyme involving the heart or brain
Avoid ceftriaxone in neonates because of impaired biliary metabolism
Cefotaxime (superior to ceftriaxone in neonates, spontaneous bacterial peritonitis)
Ceftazidime has pseudomonal coverage

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11
Q

Fourth Gen Ceph (Cefepime)

A

Used to treat Neutropenia and fever, Ventilator-associated pna

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12
Q

Fifth Gen (Ceftaroline)

A

Gram-negative bacilli and MRSA, not pseudomonas

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13
Q

Adverse effects of Cephalosporins

A

Cefoxitin and cefotetan deplete prothrombin and increase risk of bleeding
With ceftriaxone, there is inadequate biliary metabolism

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14
Q

Carbapenems (imipenem, Meropenem, Ertapenem, Doripenem)

A

(Ertapenem does not cover Pseudomonas)
Carbapenems cover gram-negative bacilli, including many that are resistant, anaerobes, strptococci, and staphylococci. They are used to treat neutropenia and fever

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15
Q

Aztreonam

A
Only drug in the class of monobactams
Exclusively for gram-negative bacilli including Pseudomonas
No cross-reaction with penicillin
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16
Q

Fluoroquinolones (Ciprofloxacin, Gemifloxacin, Levofloxacin, Moxifloxacin)

A

Best therapy for community-acquired pneumonia, including penicillin-resistant pneumococcus
Gram-negative bacilli including most pseudomonads
Ciprofloxacin for cystitis and pyelonephritis
Diverticulitis and GI infections, but ciproloxacin, gemifloxacin, and levofloxacin must be combined with metronidazole because they don’t cover anaerobes except for moxifloxacin. Moxifloxacin can be used as a single agent for diverticulitis and does not need metronidazole.

17
Q

Quinlolones cause

A

Bone growth abnormalities in children and pregnant women
Tendonitis and Achilles tendon rupture
Gatifloxacin removed because of glucose abnormalities

18
Q

Aminoglycosides (Gentamicin, Tobramycin, Amikacin)

A

Gram-negative bacilli (bowel, urine, bacteremia)
Synergistic with beta-lactam antibiotics for enterococci and staphylococci
No effect aginst anaerobes, since they need oxygen to work
Nephrotoxic and ototoxic

19
Q

Doxycycline

A

Chlamydia
Lyme disease limited to rash, joint, or seventh cranial nerve palsy
Rickettsia
MRSA of skin and soft tissue (cellulitis)
Primary and secondary syphilis in those allergic to penicllin
Borrelia, Ehrlichia, and Mycoplasma
Adverse effects: tooth discoloration (children), Fanconi syndrome (Type II RTA proximal), photosensitiviy, esophagitis/ulcer

20
Q

Trimethoprim/Sulfamethoxazole

A

Cystitis
Pneumocystis pneumonia treatment and prophylaxis
MRSA of skin and soft tissue (cellulitis)
Besides rash, it causes hemolysis with G6PD deficiency and bone marrow suppression because it is a folate antagonist

21
Q

Beta-Lactam/Beta-Lactamase Combinations

A
Amoxicillin/clavulanate
Ticarcillin/clavulante
Ampicillin/sulbactam
Piperacillin/tazobactam
Beta-lactamase adds coverage against sensitive staplylococci to these agents. They cover anaerobes and are a first choice for mouth and GI abscess
22
Q

MRSA drugs

A

Telavancin, Dalbavancin, Tedizolid, Oritavancin

23
Q

Gram-positive Cocci: Staphylococci and Streptococci

A

Oxacillin, cloxacillin, dicloxacillin, nafcillin
First-generation, cephalosporins: cefazolin, cephalexin
Fluoroquinolones
Macrolides (azithromycin, clarithromycin, erythromycin) are third-line agents because they have less efficacy than oxacillin or cephalosporins. Erythromycin is also more toxic

24
Q

Oxacillin (Methicillin)-Resistant Staphylococcus

A
These are best treated with:
Vancomycin
Linezolid: reversible bone marrow toxicity
Daptomycin: elevated CPK
Tigecycline
Ceftaroline
Telavancin
25
Q

Anaerobes

A

Oral(above the diphragm) - Penicillin (G, VK, ampicillin, amoxicillin), clindamycin
Abdominal/gastrointestinal - Metroniadazole, beta-lactam/lactamase combinations

26
Q

Gram-Negative Bacilli (E. coli, Klebsiella, Proteus, Pseudomonas, Enterobacter, Citrobacter)

A
These organisms cause infections of the bowel (peritonits, diverticulitis); urinary tract (pyelonephritis); and liver (cholecystitis, cholangitis)
All of these agents cover gram-negative bacilli:
Quinolones
Aminoglycosides
Carbapenems
Piperacillin, ticarcillin
Aztreonam
Cephalosporins