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Dermatology Pharmacology > Soft Tissue Infections > Flashcards

Soft Tissue Infections Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the most common causes of uncomplicated (no predisposing factors) skin infections in immunocompetent people?

A

S. aureus and GAS

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2
Q

What drugs are used in the treatment of uncomplicated non-MRSA skin infections?

A
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3
Q

What drugs are used in the treatment of Community acquired MRSA skin infections?

A
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4
Q

What drugs are used in the treatment of Serious MRSA skin infections?

A
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5
Q

What drugs are used in the treatment of polymicrobial skin infections?

A
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6
Q

What are your first line drugs in the treatment of non-MRSA skin/soft tissue infections?

A

Use ß-lactamase resistant Penicillins: Dicloxacillin, Nafcillin, Oxacillin

1st Gen Cephalosporins: Cephalexin, Cefazolin

**only if allergic use Lincosamides like Clindamycin or cell wall synthesis inhibitors like Vanc****

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7
Q

How does a penicillin allergy reaction present?

A

• Urticaria, Angioedema, Bronchospasm, Anaphylaxis

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8
Q

What causes the problem with 1st and 2nd generation cephalosporins also causing allergic reactions in people that are allergic to penicillin?

A

R1 side chain, NOT the actual ß-lactam structure

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9
Q

Note: You can reduce the risk of a penicillin allergy-cephalosporin cross reaction if you select drugs that have different R1 chains. If you do this there is almost no chance of cross reaction.

A

Note: You can reduce the risk of a penicillin allergy-cephalosporin cross reaction if you select drugs that have different R1 chains. If you do this there is almost no chance of cross reaction.

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10
Q

If someone was allergic to Penicillin G, which cephalosporin would you want to avoid giving this person?

A
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11
Q

If someone was allergic to Ampicillin, what cephalosporins would you definitely not want to give them?

A
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12
Q

If someone is allergic to amoxicillin, what cephalosporins would you definitely not want to give them?

A
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13
Q

What resistance mechanisms do organisms use against ß-lactams?

A
  • Lack cell wall (mycobacteria, etc)
  • ß-lactamase, altered PBPs, efflux, and Reduced permeability
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14
Q

What is the MOR to lincosamides?

A

Methylation or Mutation of the 50S ribosomal subunit

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15
Q

What is the MOR to Vancomycin?

A
  • Gram negatives are intrinsically resistant
  • D-lac substitution for D-ala
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16
Q

What is the primary organ toxicity to worry about with penicillins/cephalosporins?
• what do we do in cases of dysfunction in this organ?
• which penicillins are the exception? how are they excreted?

A

Most penicillins are eliminated in the Kidney - reduce dose because elimination will be reduced. Naficillin, Oxacillin, and Dicloxacillin are excreted via BILIARY excretion. (no dose adj. necessary)

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17
Q

How is vancomycin eliminated?
• do you need to dose adjust in renal dysfunction?

A

Eliminated via Hepatic and Renal
• DOSE adjust in renal dysfunction

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18
Q

Do you ever give Vancomycin PO for systemic infections?
• why or why not?

A

NO, Vancomycin has very poor bioavailability - only give PO in enterocolitis (C. diff)

19
Q

Side effects of Vancomycin?

A
  • *Red Man Syndrome** (histamine-related thrombophlebitis)
  • *8th Cranial Nerve Damage** (hearing loss)
  • *Reversible Nephrotoxicity** with transient BUN elevation, hyaline and granular casts in the urine
20
Q

What drugs used in the treatment of non-MRSA staph skin infections can cause interstitial nephritis?

A
21
Q

Between Dicloxacilllin, Nafcillin, and Oxacllin:
• which can cause elevated LFTs?
• Which is given IV?

A
22
Q

What side effect do the cephalosporins used to treat MSSA staph infections have in common with clindamycin?

A

Possibility of causing Stephen Johnson Sydrome

23
Q

What drug used to treat MSSA skin and soft tissue infections might cause C-diff infections?

A

Clindamycin

24
Q

Which Cephalosporin for MSSA could be given outpatient?

A

Cephalaxin b/c its PO and Cefazolin is IV/IM

25
Q

What group of drugs should you never use in the treatment of MRSA infections whether nosocomial or community acquired?

A

Fluroquinolones - resistance is rapidly conferred against these drugs

26
Q

What drugs used in the treatment of CA-MRSA skin infections bind to 50S ribosomal subunits?
• which bind to 30S?

A
27
Q

What are the only drugs used in the treatment of CA-MRSA that do not act on bacterial ribosomes?

A

TMX-SMX

28
Q

What are some mechanisms of resistance toward Linezolid?

A

• Mutation of 23S rRNA and ribosomal proteins L3 and L4 - this ability is transferred via plasmid that carries Cfr rRNA methyltransferase

• Biofilms

***Knowing resistance mechanisms here are important because Linezolid near your final line of drugs***

29
Q

If a pregnant women gets a community acquired MRSA skin infection, what drug(s) indicated for use in these infections do you definitely not want use?

A

Do not use TMX-SMX, or any tetracycline

30
Q

What drugs used in the treatment of CA-MRSA would increase your risk of getting a sunburn?

A

TMX/SMX, Minocycline, Doxycycline

31
Q

What are some unique side effects of Linezolid?

A

The most important to remember being: myelosuppression, peripheral and optic neuropathy, lactic acidosis, serotonin syndrome

32
Q

What is the mechansim of toxicity that leads to linezolid optic nerve toxicity?

A

Mitochondrial Dysfunction of the optic nerve because mitochondria use ribosomes that closely resemble bacterial ribosomes

33
Q

What are some symptoms to look for to see if a patient is getting Serotonin Syndrome?
• how long does it take these symptoms to appear?

A

**Most of these symptoms occur within 6 hours**

Mental Status Changes
Autonomic Hyperactivity
Neuromuscular Abnormalities

(muscle spasms etc)

34
Q

What drugs are associated with serotonin syndrome?

A
  • SSRIs
  • SNRIs
  • TCAs
  • MAOIs
  • Some Opiates
  • Isoniazid
  • Buspirone
  • Triptans
  • Amphetimines
  • Procarbazine
  • Bromocriptine
  • Psychotropic Drugs

HERBALS
• St. Johns Wort
• Ginseng

35
Q

What are your treament options for serious MRSA infections?
• why would you prefer one over the other?

A

Treatment options for Serious MRSA are:
• Vancomycin - bactericidal, good emprical tx.
• Linezolid - can stop toxin production, but not bactericidal
• Daptomycin - bactericidal, maybe good for VRSA

36
Q

What is the appropriate treatment for a polymicrobial bacterial skin and soft tissue infection?

A

Add a MRSA drug (Vanc., Dapto, or Linezolid) to a broad-spectrum parenteral antibiotic like:
• Pip/Tazo
• Impi/Cilastin
• Meropenem
• Ceftaroline

37
Q

Ceftaroline fosamil
• MOA
• Common adverse effects
• Elmination

A

MOA
This is a Vth generation Cephalosporin so if inhibits PBPs needed to make cell walls - BROAD SPECTRUM

Adverse Effects:
• Rash, N/D/constipation, Hypokalemia
• C. diff, ALT/AST elevation, and Hemolytic Anemia may also be seen

Elimination:
• Primarily Renal Elimination

38
Q

What does Cilastin do?

A

• Prevents metabolism of Imipenem by brush border dihydropeptidase to reno-toxic products

39
Q

What is the MOA of Daptomycin?

A
40
Q

What are some side effects to watch out for with Daptomycin?
• How can you monitor this?

A

Monitor the patient’s CK to see how much muscle breakdown is occurring

41
Q

What side effects are associated with Pip/Tazo?

A
42
Q

What side effects are typically associated with the carbapenems?

A

Note that CNS toxicity (siezures) are only really associated with Imipenem

43
Q

Remember to monitor BUN and Creatinine in patients taking beta lactams other than Naficillin, Oxacillin, or D-cillin and dose adjust for kidney dysfunction

A

Dermatology Pharmacology (11 decks)

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