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Spring Semester Exams > Pharm III > Flashcards

Pharm III Flashcards

1
Q

Bone and joint infections are extensions of what?
Exceptions?

A

-extension of extracellular fluid
-joint infections with excessive purulent debris
-devitalized bone fragment
-surgical implants and biofilm

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2
Q

What empiric therapies can we use to treat osteomyelitis?

A

-cephalosporins (injectable)
-Clindamycin
-clavamox
-TMS combos
-fluroquinolones

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3
Q

How do tetracyclines work in the bone?

A

-reach high concentrations in the bone
-chelate to the bone, form depot

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4
Q

What should be used whenever possible with bone infection?
What is preferred?

A

-local or regional therapies, including surgical intervention
-Regional limb perfusion, limited to distal limb structures

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5
Q

Intra-articular is limited to what?

A

-proximal limb, cervical

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6
Q

What drugs do we use to lavage joints?

A

-amikacin
ceftiofur

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7
Q

When should we use antibiotics for dentals?

A

-diagnosed infection (osteomyletits that cant be removed, cellulitis in surrounding tissues)
-predisposing factors (immunosuppression, underlying heart disease, renal and hepatic disease)

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8
Q

What bacteria is often present in the mouth

A

Anaerobes

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9
Q

What antibiotics can be used for the mouth?

A

-amoxicilin sulbactam
clindamycin
doxy, chlormaphenicol, metronidazole

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10
Q

What can doxirobe gel be be used for?

A

-stage 2-4 periodontal disease
-periodontal pockets that are greater than 5 mm deep
-sole therapy in stage 2 or 3
-combined with other therapies in stage 4

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11
Q

What antibiotics can we use for an immunosuppressed patient with the presence of a persistent fever

A

-FQ plus potentiated aminopenicllin
-fq plus cephalosporin
Horses (aminoglycoside + beta lactam, FQ+ beta lactam, high dose ceftiofur)

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12
Q

What spectrum of therapy do we use for life-threatening sepsis/

A

broad spectrum therapy

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13
Q

What bacteria do we often see with bacterial endocarditis
What do we culture?

A

staph, strep, and E.coli
-eryosipholothrix, corynebacterium
-bartonella,
-many other species including anaerobes
-blood

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14
Q

What kind of antibiotic do we pick for bacterial endocarditis?

A

-broad spectrum, IV, bactericidal
usually peniclillin+ fluroquinolone

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15
Q

What do we use to treat bartonella causing bacterial endocarditis?

A

-azithromycin +/- amikacyin
-doxy, amoxicillin, enrofloxacin, rifampin
-doxy and enro/prado

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16
Q

What do we culture for hepatobiliary disease?

A

-tru cut biopsy
-start empiric therapy before we collect our sample

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17
Q

What antibiotics do we ue to treat hepatobiliary disease in dogs and cats?

A

-clavomox, enrofloxacin, metronidazole

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18
Q

What drugs do we use to treat hepatobiliary disease in horse?

A

-TMS, enro, metronidazole

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19
Q

What organisms cause hepatobiliary disease

A

-E.coli, enterococcus, anaerobes

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20
Q

What antibiotics are eliminated in the bile?

A

-chloramphenicol, macrolides, clindamycin, doxy

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21
Q

What is enrofloxacin known to cause in boxers?

A

-histiocytic ulcerative colitis

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22
Q

What is metronidazole used to treat?

A

-Giardia, clostridium

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23
Q

What is tylosin responsive diarrhea

A

-middle age large breed dogs
-chronic diarrhea

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24
Q

What do we use oxytet for in horses?

A

oxytet

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25
Q

If a horse has bronchopneumonia, what drug do we pick

A

TMS

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26
Q

What bacteria have multiple drug resistance?

A

-methicillin resistant staphylococus
-extended spectrum beta lactamase bacteria
-enteroccocus sp

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27
Q

What is MRSA

A

-S. auerues organisms resistnat to the anti-staphylococcal penicillins
-methicillin, oxacillin

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28
Q

What is resistant mediated by with MRSA

A

-MecA gene
-encodes for penicllin binding protein 2a
-low binding affinity for B-lactam antibiotics
-resistant to ALL beta-lactam antibiotics

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29
Q

What are risk factors for MRSA

A

-Prior administration of antimicrobial drugs (Beta lactams and fluroquinolones in dogs)
IV catheterization

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30
Q

What are the most common sites to find MRSA

A

-EAR, SKIN
-can treat these topically

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31
Q

What is MRSP a common cause of?

A

-canine pyoderma

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32
Q

What is MRSE

A

-methicillin resistant staphylococcus epidermis
-commonly seen in horses

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33
Q

How do we treat MRSA

A

-based on culture and sensitivity to

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34
Q

What are MRSA/MRSP routinely sensitive to?

A

-doxy
-chloramphenicol
-TMS
-rifampin
-Dont always need the big gun

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35
Q

What is mupirocin

A

-Bactoderm
-indicated for topical treatment of canine bacterial infections of the skin
-Superficial pyoderma (susceptible strains of Staph aureus and staph intermedius)

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36
Q

Where are extended spectrum betalactamses found?
What do they produce and what do they do?

A

-gram negative bacteria
-produce B-lactamses, which inactivate penicillins and inactive B-lactamse resistant cephalosporins

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37
Q

Where does resistance come from with ESBL

A

-plasma mediated
-encode other genes that infer resistance to other antimicrobials of this class

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38
Q

What can we use to treat ESBL

A

-amikacin
-imipenem
-clavamox

39
Q

What is the number one ESBL in vet med?

A

E.coli
-pseudomonas and samonella

40
Q

What enteroccoi have resistnace?

A

-E.faecalis and E.faecium

41
Q

What kind of pathogens are E.faecalis and E.aecium

A

commensal organisms in the GI tract
-not typically virulent but multi drug resistant

42
Q

Where do we commonly find E.coli
How do we treat

A

-in the urinary tract of small animals
-treat the primary organism

43
Q

When should we treat E.coli with a urine culture?
What do we treat with?

A

-pure, heavy growth is cultured
-animal is showing clinical signs
–ampicillin,

44
Q

What is rifampin used for?

A

-gram positive and gram negative bacteria
-mostly bacteriostatic
-noted for intracellular activity

45
Q

Rifampin is sometimes used for>

A

Monotherapy for MRSP pyoderma

46
Q

What do we worry about rifampin with dogs?

A

-dogs -> hepatic enzymes and hepatotoxicity
-turns urine, sweat and tears a red orange color

47
Q

What do we use to treat R.equi in foals

A

macrolide plus rafampin

48
Q

What kind of drugs are carbapenems
Spectrum of activity

A

-B lactam antibiotics
-impenem, meropenum
-gram negative, gram positive, and anaerobic bacteria.
-May be effective against ESBL, not effective against MRSA and enterococci

49
Q

Describe Imipenum
What is Cilastatin

A

-administered IV, pain on SC/IM
-converted to nephrotoxic metabolite in the renal tubules

inhibitor of renal rubular dipeptidase

-Combine these two drugs to increase active drug in the urine

50
Q

Meropenem

A

-best choice for use in small animals
-easily administered SC
-less likely to be nephrotoxic
-need higher doses for psuedomonas

51
Q

What side effects do we see with carbapenems?

A

-vomiting, diarrhea, hypersensitivy reactions
-nephrotoxicity
-seizures with rapid IV administration

52
Q

What is the mechanism of vancomysin

A

-cell wall inhibitor and bactericidal

53
Q

What is the mechanism of resistance for vancomysin?

A

-not affected by B-lactamse or MECa

54
Q

What is the vancomysin spectrum

A

-gram positive aerobes and anaerobes only

55
Q

What are the side effects of vancomysin

A

-allergies, phelbitis, nephrotoxic

56
Q

What do we use vancomycin for?

A

-serous, resistant life threatening infections
-only when C&S dictate

57
Q

What is Linzeolid

A

Oxazolidone -> protein synthesis inhibitor
-bacteriostatic
-gram positive aerobic spectrum (E.coli, strep, staph)

58
Q

Linzeolid is an oral option for?

A

MRSP

59
Q

What is the mechanism that Nitrofuran uses?

A

-blocks bacterial energy producing pathways
-bactericidal in urine only

60
Q

Spectrum of activity for Nitrofuran

A

-gram negative and gram positive aerboci in urine ONLY
-includes most E.coli and staph causing UTIs in dogs

61
Q

What is Equifur

A

-treatment of UT

62
Q

PK of Nitrofuran

A

rapidly excreted unchanged in urine
-use this before reaching for imipenem

63
Q

adverse effects of nitrofuran

A

-GI, hepatopathy

64
Q

Fosomycin spectrum

A

-Staph, Enteroccocus
-E. coli, enterobacter, Klebseilla, proteus
-some gram positive anaerobes

-used for UTI

65
Q

When you do a culture, what is assumed?

A

-sample was appropriately collected
-sample was appropriately transported to a lab
-clinical evidence of inflammation in the patient

66
Q

What is MIC

A

-lowest concentration of a drug that completely inhibits growth of the bacteria

67
Q

What is a breakpoint MIC

A

-maxmium bacterial MIC that predicts succcessful therapy
-Determine S,IR

68
Q

What are the four steps to determine Breakpoint MIC

A
  1. Evaluate population MIC
  2. consider PK/PD parameters
  3. use statistical modeling to predict population responses
  4. use clincial data
69
Q

For time dependent drugs, T>MIC for 50% of dosing interval for what patients?

A

immunocompotent patients

70
Q

What is the final step to determine in the patient?

A

Final step is to confirm it works in the patient

71
Q

What happens if the data isnt available for your source

A

-That antibiotic is not reported on the C&S
-Breakpoints for other species used
-Reported as NI

72
Q

What does susceptible mean on a culture report
Intermediate
Resistant

A

-treatment of this bacteria with this antibiotic has high likelihood of therapeutic success
-bacterial MIC is less than or equal to breakpoint MIC

-therapeutic effect is uncertain
-may have efficacy in body sites where the drugs are phsyiologically concentrated

-treatment of this bacteria with this antibiotic has high likelhood of therapeutic failure
-Bacterial MIC is greater than or equal to breakpoint MIC

73
Q

When do we have to interpret SIR and differently?

A

susceptiblity tests can underestimate -> surface infections
urinary bladder

Tests can overestimate concentrations at these sites ->intracellular bacteria, eye, prostate/CNS

74
Q

Do enteroccoi always need to be treated?

A

NO

75
Q

What does methicillin resistnat mean?

A

-the organism will be resistant to all beta lactams drugs, including all generations of cephalosporins

76
Q

-If you have a culture result that says 3rd generation ceph R=
-3rd Generation R+ amoxi/clav S?

A

broad spectrum beta lactamase production
-likely ESBL

77
Q

What is psuedomonas intrinsically resistant to?

A

-beta lactams
-most cephalosporins
-tetracylines
-chloramphenicol
-TMS
-easily develops to fluroquinolones

78
Q

What antibiotics have intrinsic resistnace?

A

-aminoglycosides
-cephalosporins
-cindamycin
-TMS

79
Q

If something is susceptible to tetracycline?

A

-likely susceptible to doxy/mino

80
Q

If not susceptible to tetracycline?

A

may still be susceptible to doxy/mino

81
Q

If susceptible to erythromycin

A

likely susceptible to azithro/clarithromycin

82
Q

Utis in male intact adult dogs should come with a high suspicion of what?

A

Complicated/recurrent disease

83
Q

What would be number one on your differential diagnosis list?

A

-prostatitis

84
Q

What shoudl you do before prescirbing 4-6 weeks of a fluroquinolone

A

-confirm prostatitis

85
Q

How can we diagnose prostatsis?

A

-ultrasound
-discordance between urine and prostatic fluid culture results can occur
-drain prostatic abscesses
-fluoroquinolone while awaiting culture and susceptibility treating

86
Q

How long do we treat acute prostatitis for?

A

4 weeks

87
Q

If you have a dog with prostatitis, how do you follow up?

A

-castration in dogs not intended for breeding
-monitor prostate size by ultrasound

88
Q

Does enrofloxacin concentrate in the prostate?

A

Yes but it does not concentrate as well as it does in urine

89
Q

Do we think an I is a potential choice for enro with prostatis?

A

No

90
Q

What criteria are used to determine ESBL resistance

A

CeftazadimeWh

91
Q

What veterinary drug would be equivalent to ceftazidime resistnace?

A

-cefpodoxime

92
Q

What is the best way to treat Ernie’s abscess?

A

-Drain and debride

93
Q

Where is TMS inactivated?

A

Pus abscessess

94
Q
A

Spring Semester Exams (5 decks)

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