Quiz 7 Flashcards
(85 cards)
1
Q
Bacterial susceptibility is determined by the _____ around each disc.
A
radius
Disk diffusion technique
2
Q
bacteriostatic (6) STECC
A
- Sulfonamides
- Tetracyclines
- Erythromycin
- Clindamycin
- Chloramphenicol
3
Q
Narrow spectrum ABX (3)
A
- Penicillin G
- Erythromycin
- Clindamycin
4
Q
concentration dependent ABX (2)
A
- Aminoglycosides
- Flouroquinolones
5
Q
Post-Antibiotic Effect (PAE):
A
- Some antibiotics continue to suppress the growth of bacteria even after the antibiotic is no longer detectable
- PAE demonstrated for virtually all antimicrobials
- PAEs can be decreased in acidic (infected) media
- During the PAE phase, bacteria are more susceptible to killing by leukocytes
6
Q
All gram negative bacteria have resistance to __________.
A
vancomycin
7
Q
Mechanisms of acquired resistance
A
- Decreased permeability
- Increased efflux pumps
- Inactivation
- Modification of the antimicrobial target
8
Q
Look at slide 17
A
.
9
Q
Need ___________ coverage for cutting through skin
A
Gram positive
10
Q
Impaired host defenses
A
Anatomical (i.e. ulceration)
Secondary:
- Neutropenia
- Aspleenia
- Malignancy
- HIV
- Immunosuppressant therapy
11
Q
Pregnant Pharmacokinetics
A
- Increased V.d (volume of distribution)
- Increased GFR
12
Q
Ok in Preggos:
And if necessary?
A
- PCN
- Erythromycin
- cephalosporins
If Necessary:
- AminoGlycosides
- Isoniazid
13
Q
_________ in pregnant women is associated with acute fatty necrosis of the liver, pancreatitis, and possible renal injury.
A
Tetracycline
14
Q
C. Diff: Pathogenesis is typically toxin-mediated with bacteremia extremely rare, what toxins?
A
- Enterotoxin A
- Cytotoxin B
15
Q
C. Diff Tx (2)
A
- Oral vancomycin
- Dificid (fidaxomicin)- similar cure rates as vanco, reduced recurrence for moderate to severe infection
16
Q
C.Diff and concurrent infections
A
-Continue C. difficile therapy also and extend the course for 5 to 10 days after the completion of the other antibiotics
17
Q
Look at slide 37
A
.
18
Q
Look at early C & S report, clusters usually _____
A
staph
19
Q
ABX timing prior to incision?
- Ancef
- Vanco
A
- Ancef 60 mins
- Vanco 120 mins
20
Q
Vanco, ___ mg/kg actual body weight up to ______ mg
A
15
2500
21
Q
Cell wall integrity
A
Beta Lactams
22
Q
DNA synthesis
A
Flagyl
23
Q
DNA gyrase
A
Quinilones
24
Q
RNA Polymerase
A
Rifampin
25
Phospholipd Membranes
polymixins
26
Cell wall Synthesis (6)
- D-Cycloserine
- Vanco
- Bacitractin
- PCN
- Cephalosporins
- Cephamycins
27
Bind to the penicillin binding protein (PBP) due to similar structure to D-alanyl-D-alanine
Beta Lactams
28
What evolved to cause PCN resistance
Beta lactamase ring
29
Beta lactamase inhibitors (3), also called
- Sulbactan
- Tazobactam
- Clavulanic Acid
"Suicide Inhibitors"
30
PCN facts: halflife, elimination
0.5-4 hours
Renal
31
PCN AE's:
Jarisch-Herxheimer Rxn - releases toxins causing flu-like sx
32
MRSA and C.difficile rates are _____ in patients with reported PCN allergy.
higher
33
Amoxicillin halflife, elimination
1-3 hours
Renal
34
wide tissue distro including CNS when inflammed
Ampicillin
35
Covers Beta-lactimase enzyme
- Oxacillin
| - Need more here (*)
36
wide distro including inflamed meninges
- Nafcillin
- Oxacillin
- Dicloxacillin
37
AE's of Prolonged bleeding time, and Hypokalemia
- Timentin
| - Zosyn (neutropenia at high doses)
38
Cafalosporins that cover MRSA Gen and type (2)
5th Gen
- Ceftobiprole
- Cefteroline
39
Keflex/Ancef halflife, elimination, AEs. Does not cover?
- Keflex 0.5 hours/Ancef 1.8 hours
- Renal
- Hypersensitivity rxns, CBC abnormalities, generally safe
Does not cover MRSA
40
Difference in 3rd gen caphalosporins
- Less gram positive activity
- More gram positive activity
- Anti-pseudomonal
- Cross CNS (good for Meningitis)
41
Elimination of 50% renal, sig biliary excretion
Cefoxatime
42
“taz”manian devil, destroys everything
Ceftazidime (Fortaz)
43
Ceftriaxone (rocephin): Penetration, elimination, AE
CSF penetration
Hepatic and Biliary
AE: Biliary sluding, precipitates with Ca in the IV
44
3rd gen
4th gen
5th gen
Summaries
3rd gen - sees more resistance, not created equal
4th gen - can still kill off beta lactamase bacteria, still broad spectrum
5th gen - kills everything
45
Carbapenems, covers? Seizure risks?
- Covers Pseudomonas
- High risk Seizures - Imipenem
- Low risk seizures - Ertapenum
46
IV vanco can still give someone C diff
.
47
Vancomycin AE's (4)
Redmans, Nephrotoxic, Ototoxic, Thrombocytopenia
48
Vanco Random
Dosing based on trough levels
Red mans not true allergy, just infusion rate issue
Losing gram negative coverage on surgical prophylaxis, redose surgery lasting >16 hours
49
Slows down ribosomal formation within bacteria
Gets inside and changes way protein interacts, slowly kills of bacteria
Covers?
Linezolid
Covers VRE
50
Linezolid AEs
Myelosuppression (anemia, leukopenia, pancytopenia, thrombocytopenia)
51
Linezolid (zyvox) drug interaction with*
MAO inhibitors, hold antidepressants during therapy
52
Inhibits protein synthesis
Macrolides
53
- Half life = 68 hours long
| - May prolong QT interval torsades
Azithromycin
54
Best coverage of respiratory bugs
Azithromycin
55
Significant GI toxicity, may prolong QT
Erythromycin
56
AEs of Ketolides (4)
- blurred vision
- QT prolongation
- N/V
- LFT increase
57
“I’m gonna be a floroquinolone and unzip your genes”
.
58
Fluoroquinolones AEs (8)
- arthropathies(*)
- QT prolongations
- CNS excitement
- altered glucose homeostasis
- seizure activity
- agitation
- confusion
- achilles tendon rupture(*)
59
DOC for bacterial GI infections (traveller’s)
Cipro
60
Increased resistance due to efflux pumps
Cipro
61
Best strep coverage
Moxifloxacin (Avelox)
62
It is the first fluoroquinolone antibiotic with activity against methicillin-resistant Staphylococcus aureus (MRSA) and, unlike the other fluoroquinolones, is not associated with QT prolongation or photosensitivity
Delafloxacin
| In addition to gram-positive organisms such as MRSA, delafloxacin targets gram-negative pathogens
63
Bind irreversibly to the 30S ribosomal unit
Tetracyclines
64
Teeth will be yellow forever, drug and age. Also?
Tetracyclines
(2nd/3rd trimester through the age of 8)
-Also, photosensitivity
65
Drug interactions: Warfarin, PHT, CBZ, oral contraceptives
Doxycycline
66
Similar to TCNs for TCN resistant bacteria
AE of?
Tigecycline
| high incidence of N/V
67
AE: prolongs NMBs, and? (2)
Aminoglycosides
Oto and Nephrotoxic
68
When used for gram positive, use with a cell wall destruction agent (examples?)
Gentamycin
Ex: Cell wall synthesis and cell wall integrity agents: list....
69
2 bacteriostatic = bactericidal, example? does what?
Bactrim (treats community MRSA)
decreases folic acid
70
Alternative to Vanco for MRSA and VRSA
Bactrim
71
Sulfa allergic cannot admin _________
bactrim
72
Bactrim AEs (4)
- pancytopenia
- neutropenia
- TTP
- Stevens Johnson
73
AEs: confusion, peripheral neuritis, pulmonary complications, hepatic damage, blood dyscrasias
Macrobid
74
Can cause pulmonary fibrosis
Macrobid
75
Highest C.diff risk(*)
Clindamycin (Cleocin)
(Also NMB
76
Bacteria reductases reduce nitrofurantoin to reactive metabolites that inhibit bacterial citric acid cycle as well as DNA, RNA, and protein synthesis
Macrobid
77
Reduced by the pyruvate: ferredoxin oxidoreductase system, decreasing intracellular conc of drug and promoting further diffusion into the cell; toxic/ short lived intermediateds and free oxygen radicals are formed; these toxic compounds interact with DNA causing strand breakage and helix unwinding, leading to cell death
Flagyl
78
Disulfuram like rxns with EtOH? ANd interaction with?
Flagyl
Coumadin interactions
79
AEs: Limb/muscle pain, myalgias, incrased CPK
Daptomycin
80
Potent inducer of the CYP 450 system with significant interactions speed up meds half-life (2). How long?
Rifampin and Rifabutin
Can see drug interactions up to 3 months after DC
81
AEs: hallucinations, tremors, agitation,
Acyclovir, valacyclovir
82
Option for those unresponsive to previous agents (antivirals)
Foscarnet
83
AEs of Amphoteracin B (2)
- Renal Failure
| - K and Mg wasting
84
CYP3A4 inhibitor, prolongs drugs
Fluconazole
85
AE of all the "-conazoles"
increase LFTs
