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Pharmacology > Resistant Infections > Flashcards

Resistant Infections Flashcards

1
Q

What are the three types of bacteria we discussed that exhibit multiple drug resistance?

A

Methicillin Resistant Staphylococcus sp (MRS)

Extended Spectrum B-Lactamase bacteria (ESBL)

Enterococcus

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2
Q

What is MRSA?

A

Staph aureus organisms resistant to the anti-staphylococcal penicillins, methicillin and oxacillin

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3
Q

T/F: If a staph organism is resistant to oxacillin or methicillin, there is still a chance it could be susceptible to cefazolin.

A

False - will be resistant to ALL beta-lactam antibiotics

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4
Q

Resistance is MRS is mediated via _________

A

MecA gene

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5
Q

How does MecA work to promote resistance?

A

Encodes for penicillin binding protein (PBP) 2a

Low binding affinity for beta-lactam antibiotics

Beta-lactams work by binding and inhibiting PBP, so if they are unable to bind effectively, they won’t work

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6
Q

Risk factors for MRSA

A

Prior administration of antimicrobial drugs (FQs and beta-lactams in dogs)

IV catheterization

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7
Q

Most common site for MRSA infections

A

Ear, skin

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8
Q

Which MRS is a common cause of canine pyodermas?

A

Methicillin Resistant Staph Pseudintermedius (MRSP)

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9
Q

T/F: treatment of MRS should be based on culture and sensitivity

A

True

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10
Q

ESBLs are found in gram ______ bacteria

A

(-)

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11
Q

What do ESBLs produce?

A

Beta-lactamases…duh

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12
Q

What drugs do ESBLs like to inactivate?

A

The beta-lactams (again, duh)

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13
Q

How can we identify ESBLs in veterinary medicine?

A

Resistance to cefpodoxime (3rd gen cephalosporin) on C&S

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14
Q

Resistance for ESBLs is __________-mediated

A

Plasmid

Encode genes that infer resistance to antimicrobial of other classes

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15
Q

What are some common options for treating ESBL infections?

A

Amikacin

Imipenem/meropenem (look out for those carbapenemases though)

Clavamox might be an option for urine b/c has BLI and concentrates in urine

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16
Q

What bacteria is the most common ESBL in veterinary medicine?

A

E. coli

We also can see pseudomonas, salmonella, klebsiella

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17
Q

What is enterococci?

A

Opportunistic pathogen that likes to poke its head out when there are other powerful bacteria around

Commensal organism in the GIT

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18
Q

T/F: Enterococci are typically virulent and multi-drug resistant, so we must treat them immediately.

A

False - not typically virulent, but do express multi-drug resistance

We do not commonly treat these

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19
Q

Enterococci like to tango with _________

A

E. coli

20
Q

In general, how do we treat enterococci?

A

Treat the primary organism and enterococci will go away

21
Q

When do we treat enterococci?

A

Pure heavy growth is cultured

Animal has clinical signs

22
Q

What are the two most commonly used drugs to treat enterococci?

A

Ampicillin
Vancomycin in people

23
Q

SoA of Rifampin

A

Gram-positive and gram-negative aerobes

24
Q

Rifampin has a low incidence of resistance currently, but is noted for creating resistance during treatment. What are some ways we an avoid the development of resistance?

A

Using in combination with other drugs

Short treatment times

25
Q

The most common veterinary uses of rifampicin…

A

Rhodococcus in foals

MRSP pyodermas in dogs/cats (10d treatment)

26
Q

Adverse effects associated with rifampin

A

Dogs - elevated liver enzymes +/- hepatotoxicity

Turns urine, sweat, and tears a red or orange color

Foals when combined with doxy - hemolytic anemia, hepatotoxicity

27
Q

Rifampin is almost always combined with a second drug like __________ for the treatment of R equi in foals

A

A macrolides (clarithromycin)

28
Q

Carbapenems are part of the major class of __________

A

Beta-lactams

29
Q

Name the two carbapenems

A

Imipenem
Meropenem

30
Q

SoA of carbapenems

A

Incredibly broad spectrum

Gram (+) and (-) aerobes and anaerobes

NOT for MRS and enterococci

31
Q

What are carbapenems reserved for in veterinary medicine?

A

Life-threatening, multi-drug resistant ESBL infections, pseudomonas

32
Q

Because imipenem can cause _______toxicity, it is combined with _________.

A

Nephro

Cilastatin

33
Q

Adverse effects with carbapenems

A

V, D, HSR

Nephrotoxicity

Rapid IV admin or pre-existing renal disease can lead to seizures

34
Q

SoA of vancomycin

A

Gram positive aerobes and anaerobes only!!

35
Q

Vancomycin is a _________ and its mechanism of action is _____________

A

Glycopeptide

Cell wall inhibition

36
Q

Vancomycin is the first line treatment for ___________ and _________ in people

A

Enterococcus
MRSA

37
Q

Oxazolidinone has a ______________ spectrum

A

Gram positive aerobic

38
Q

MoA of oxazolidinone, a linezolid

A

Protein synthesis inhibitor (50s)

39
Q

Oral availability of oxazolidinone is _______ in dogs

A

100%

40
Q

MoA of Nitrofuran

A

Blocks bacterial energy producing pathways

41
Q

Nitrofuran is bactericidal in what body fluid

A

Urine ONLY

42
Q

SoA of Nitrofuran

A

Gram negative and gram positive aerobic bacteria in URINE ONLY

43
Q

What is the most common veterinary use of Nitrofuran?

A

Resistant UTIs - gets aerobic bacteria in the URINE

44
Q

T/F: if you have a resistant UTI, ask the lab for nitrofurantoin susceptibility before reaching for imipenem

A

True - Nitrofuran is used to treat resistant UTIs b/c it is rapidly excreted unchanged in the urine and reaches high urine concentrations

45
Q

Fosfomycin hasn’t been used for much in veterinary medicine, but it has been used for __________

A

UTIs in dogs

Pharmacology (7 decks)

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