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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
If a horse has bronchopneumonia, what drug do we pick
TMS
26
What bacteria have multiple drug resistance?
-methicillin resistant staphylococus -extended spectrum beta lactamase bacteria -enteroccocus sp
27
What is MRSA
-S. auerues organisms resistnat to the anti-staphylococcal penicillins -methicillin, oxacillin
28
What is resistant mediated by with MRSA
-MecA gene -encodes for penicllin binding protein 2a -low binding affinity for B-lactam antibiotics -resistant to ALL beta-lactam antibiotics
29
What are risk factors for MRSA
-Prior administration of antimicrobial drugs (Beta lactams and fluroquinolones in dogs) IV catheterization
30
What are the most common sites to find MRSA
-EAR, SKIN -can treat these topically
31
What is MRSP a common cause of?
-canine pyoderma
32
What is MRSE
-methicillin resistant staphylococcus epidermis -commonly seen in horses
33
How do we treat MRSA
-based on culture and sensitivity to
34
What are MRSA/MRSP routinely sensitive to?
-doxy -chloramphenicol -TMS -rifampin -Dont always need the big gun
35
What is mupirocin
-Bactoderm -indicated for topical treatment of canine bacterial infections of the skin -Superficial pyoderma (susceptible strains of Staph aureus and staph intermedius)
36
Where are extended spectrum betalactamses found? What do they produce and what do they do?
-gram negative bacteria -produce B-lactamses, which inactivate penicillins and inactive B-lactamse resistant cephalosporins
37
Where does resistance come from with ESBL
-plasma mediated -encode other genes that infer resistance to other antimicrobials of this class
38
What can we use to treat ESBL
-amikacin -imipenem -clavamox
39
What is the number one ESBL in vet med?
E.coli -pseudomonas and samonella
40
What enteroccoi have resistnace?
-E.faecalis and E.faecium
41
What kind of pathogens are E.faecalis and E.aecium
commensal organisms in the GI tract -not typically virulent but multi drug resistant
42
Where do we commonly find E.coli How do we treat
-in the urinary tract of small animals -treat the primary organism
43
When should we treat E.coli with a urine culture? What do we treat with?
-pure, heavy growth is cultured -animal is showing clinical signs --ampicillin,
44
What is rifampin used for?
-gram positive and gram negative bacteria -mostly bacteriostatic -noted for intracellular activity
45
Rifampin is sometimes used for>
Monotherapy for MRSP pyoderma
46
What do we worry about rifampin with dogs?
-dogs -> hepatic enzymes and hepatotoxicity -turns urine, sweat and tears a red orange color
47
What do we use to treat R.equi in foals
macrolide plus rafampin
48
What kind of drugs are carbapenems Spectrum of activity
-B lactam antibiotics -impenem, meropenum -gram negative, gram positive, and anaerobic bacteria. -May be effective against ESBL, not effective against MRSA and enterococci
49
Describe Imipenum What is Cilastatin
-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
Meropenem
-best choice for use in small animals -easily administered SC -less likely to be nephrotoxic -need higher doses for psuedomonas
51
What side effects do we see with carbapenems?
-vomiting, diarrhea, hypersensitivy reactions -nephrotoxicity -seizures with rapid IV administration
52
What is the mechanism of vancomysin
-cell wall inhibitor and bactericidal
53
What is the mechanism of resistance for vancomysin?
-not affected by B-lactamse or MECa
54
What is the vancomysin spectrum
-gram positive aerobes and anaerobes only
55
What are the side effects of vancomysin
-allergies, phelbitis, nephrotoxic
56
What do we use vancomycin for?
-serous, resistant life threatening infections -only when C&S dictate
57
What is Linzeolid
Oxazolidone -> protein synthesis inhibitor -bacteriostatic -gram positive aerobic spectrum (E.coli, strep, staph)
58
Linzeolid is an oral option for?
MRSP
59
What is the mechanism that Nitrofuran uses?
-blocks bacterial energy producing pathways -bactericidal in urine only
60
Spectrum of activity for Nitrofuran
-gram negative and gram positive aerboci in urine ONLY -includes most E.coli and staph causing UTIs in dogs
61
What is Equifur
-treatment of UT
62
PK of Nitrofuran
rapidly excreted unchanged in urine -use this before reaching for imipenem
63
adverse effects of nitrofuran
-GI, hepatopathy
64
Fosomycin spectrum
-Staph, Enteroccocus -E. coli, enterobacter, Klebseilla, proteus -some gram positive anaerobes -used for UTI
65
When you do a culture, what is assumed?
-sample was appropriately collected -sample was appropriately transported to a lab -clinical evidence of inflammation in the patient
66
What is MIC
-lowest concentration of a drug that completely inhibits growth of the bacteria
67
What is a breakpoint MIC
-maxmium bacterial MIC that predicts succcessful therapy -Determine S,IR
68
What are the four steps to determine Breakpoint MIC
1. Evaluate population MIC 2. consider PK/PD parameters 3. use statistical modeling to predict population responses 4. use clincial data
69
For time dependent drugs, T>MIC for 50% of dosing interval for what patients?
immunocompotent patients
70
What is the final step to determine in the patient?
Final step is to confirm it works in the patient
71
What happens if the data isnt available for your source
-That antibiotic is not reported on the C&S -Breakpoints for other species used -Reported as NI
72
What does susceptible mean on a culture report Intermediate Resistant
-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
When do we have to interpret SIR and differently?
susceptiblity tests can underestimate -> surface infections urinary bladder Tests can overestimate concentrations at these sites ->intracellular bacteria, eye, prostate/CNS
74
Do enteroccoi always need to be treated?
NO
75
What does methicillin resistnat mean?
-the organism will be resistant to all beta lactams drugs, including all generations of cephalosporins
76
-If you have a culture result that says 3rd generation ceph R= -3rd Generation R+ amoxi/clav S?
broad spectrum beta lactamase production -likely ESBL
77
What is psuedomonas intrinsically resistant to?
-beta lactams -most cephalosporins -tetracylines -chloramphenicol -TMS -easily develops to fluroquinolones
78
What antibiotics have intrinsic resistnace?
-aminoglycosides -cephalosporins -cindamycin -TMS
79
If something is susceptible to tetracycline?
-likely susceptible to doxy/mino
80
If not susceptible to tetracycline?
may still be susceptible to doxy/mino
81
If susceptible to erythromycin
likely susceptible to azithro/clarithromycin
82
Utis in male intact adult dogs should come with a high suspicion of what?
Complicated/recurrent disease
83
What would be number one on your differential diagnosis list?
-prostatitis
84
What shoudl you do before prescirbing 4-6 weeks of a fluroquinolone
-confirm prostatitis
85
How can we diagnose prostatsis?
-ultrasound -discordance between urine and prostatic fluid culture results can occur -drain prostatic abscesses -fluoroquinolone while awaiting culture and susceptibility treating
86
How long do we treat acute prostatitis for?
4 weeks
87
If you have a dog with prostatitis, how do you follow up?
-castration in dogs not intended for breeding -monitor prostate size by ultrasound
88
Does enrofloxacin concentrate in the prostate?
Yes but it does not concentrate as well as it does in urine
89
Do we think an I is a potential choice for enro with prostatis?
No
90
What criteria are used to determine ESBL resistance
CeftazadimeWh
91
What veterinary drug would be equivalent to ceftazidime resistnace?
-cefpodoxime
92
What is the best way to treat Ernie's abscess?
-Drain and debride
93
Where is TMS inactivated?
Pus abscessess
94

Spring Semester Exams (5 decks)

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