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D&D Infectious Disease Midterm > Therapeutics - General Principles Pt 2 > Flashcards

Therapeutics - General Principles Pt 2 Flashcards

1
Q

what is MIC (minimum inhibitory concentration)

A

an indicator of antibiotic potency

It’s the lowest ab concentration that prevents visible growth of the bacteria after spending 24 hours in vitro

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2
Q

true or false

MIC values are very specific

A

TRUE

very specific— 1 drug-1 bug

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3
Q

3 methods of antimicrobial suceptibility testing

A

broth microdilution
E-test
Kirby-bauer test (zone of inhibition)

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4
Q

who establishes the MIC breakpoints (reference values) for each organism to each antibiotic

A

CLSI (clinical laboratory standards institute)

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5
Q

organisms can be _____,_______, or ______ to the antibiotic

A

susceptible, intermediate, or resistant

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6
Q

what is the name of the cumulative antibiotic “report card” specific for each hospital

A

an antibiogram

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7
Q

an antibiogram is useful for deciding ______ antimicrobial therapy

A

empiric

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8
Q

in an antibiogram, if the antibiotic has a high value to the organism, is it good or bad?

A

GOOD

means that it works against the organism a high % of the time
(% susceptibility)

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9
Q

when staph epi comes back in the sample, what are some important considerations

A

-could be a contaminant

-may be actual infection tho - NEED TO SEE IF THEY HAVE RISK FACTORS (ie: IV drug user or use medical devices often)

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10
Q

gram negative rods, non lactose fermenting

A

pseudomonas

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11
Q

which class of antibiotics cover pseudomonas (aerobic gram negative) but do not penetrate the lungs well

A

aminoglycosides

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12
Q

is pipercillin-tazobactam a good empiric choice for pseudomonas

A

yes - but need to look at antibiogram to confirm

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13
Q

organism MIC is 2 and MIC susceptibility breakpoint, according to CLSI, is less than or equal to 1

does this mean the organism is susceptible or resistant to the antibiotic?

A

RESISTANT

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14
Q

MIC of organism is 4 and MIC susceptibility breakpoint is less than or equal to 4

is it susceptible or resistant to the antibiotic

A

technically susceptible, but not preferred to use because it’s just at the breakpoint

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15
Q

does cefepime penetrate into the lungs and can it be used for a respiatory infection

A

YES

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16
Q

true allergy, toxicity, or intolerance

diarrhea with doxycycline

A

intolerance

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17
Q

true allergy, toxicity, or intolerance

thrombocytopenia with linezolid

A

toxicity

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18
Q

true allergy, toxicity, or intolerance

SJS with bactrim

A

true allergy

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19
Q

true allergy, toxicity, or intolerance

nephrotoxicity with gentamicin

A

toxicity

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20
Q

true allergy, toxicity, or intolerance

hives and SOB with penicillin

A

true allergy

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21
Q

IGE mediated hypersensitivity reactions – what is onset time?
what is an example?

A

within 1 hour - SUPER QUICK

ex - anaphylaxis

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22
Q

around ______% of US pts report having pen allergy, but only ___% are truly allergic

A

10%, less than 1%

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23
Q

important consideration for someone that had an IGE-mediated pen allergy years ago

A

around 80% of pts with this allergy lose their sensitivity after 10 yrs!!!
decreases by 10% each year you avoid penicillin

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24
Q

cephalosporin cross reactivity with pen allergy is around ___%

which generations is it less common

A

3%

as you move up to 5th gen, cross reactivity rate keeps decreasing

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25
Q

why are false pen allergies so detrimental

A

suboptimal treatment, more expensive, antiobitc resistance, unnecessary broadspectrum

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26
Q

most ab’s are eliminated how?

A

renally

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27
Q

how is age a consideration when giving antibiotics

A

likely pathogen can differ based on age (ie - bacterial meningitis)

ceftriaxone avoided in neonates bc of hyperbilirubinemia

ability to eliminate certain drugs (ie over 65 = decline in renal function)

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28
Q

how can hepatic function be estimated

A

child pugh score

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29
Q

3 pregnancy and lactation concerns with antibiotics

A

teratogencity
altered pharmacokinetics
antibiotic conc in breast milk

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30
Q

name 3 drugs that can cause hemolytic anemia in patients with GDPDH deficiency

A

dapsone
nitrofurantoin
primaquine

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31
Q

how are pts with diabetes a special consideration when giving antibiotics

A

poor peripheral blood flow — more difficult to treat

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32
Q

chronic lung disease, cystic firosis, and immunosuppressive diseases - how are they a consideration in antibiotic treatment

A

different pathogens

immunosuppressed have higher risk of infection

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33
Q

concern with fluoroquinolones and antacids

A

they can chelate

34
Q

how is rifampin a major concern with drug interactions

A

its a major CYP450 inducer

35
Q

linezolid + _______ is a big DDI

A

SSRIs – risk of serotonin syndrome

36
Q

which 2 antibiotic classes have a side effect of QT prolongation

A

macrolides and quinolones

37
Q

give an example of how dosing of aminoglycosides can differ based on the location of the infection

A

uncomplicated UTI vs severe infection

aminoglycosides penetrate into the urine well – dont need a veru high dose

38
Q

differentiate between the ability of cefepime vs pipercillin-tazobactam to penetrate into the CNS

A

cefepime is much better

pipercillin-tazobactam is too big

39
Q

differentiate between the ability of colistin vs polymyxin B to get into the urine

A

polymyxin does not

colistin is better

40
Q

can we use daptomycin in pneumonia??
why or why not

A

NO

it gets inactivated by the lung surfactants

41
Q

first and second line for MRSA pneumonia

A

vancomycin

2nd line is linezolid

DO NOT USE DAPTOMYCIN!!!!!!!!!! gets inactivated by lung surfactants

42
Q

pt spent 14 days in the hospital

what is 1 bacteria we definitely need to cover for and what are 2 choices

A

pseudomonas

use pipercillin-tazobactam or cefepime

43
Q

if a very severe infection, do we use IV or PO

explain

A

we can start IV and then switch to PO once controlled

44
Q

beta lactams use conc or time dependent killing

A

time dependent

45
Q

differentiate between the dosing frequency of time dependent killing vs concentration dependent

A

time dependent - DOSED MORE FRWQUENTLY (like Q8 or Q6)

conc dependent dosed less frequently

46
Q

a very high MIC means more or less resistant

A

more resistant

47
Q

name 2 antibiotic classes that use concentration dependent killing

A

aminoglycosides and fluoroquinolones

48
Q

how do we want the infusion of beta lactams to be and why

A

PROLONGED INFUSION of 304 hours over traditional 30mins- it’s time dependent!!

want to maximize duration that the pathogen is exposed to the beta lactam

time over MIC - want maximal time

49
Q

prolonged infusion of beta lactams is particularly beneficial in what 2 scenarios

A

crtically ill patients

pathogens with high MIC

50
Q

aminoglycosides are time or concentration dependent killing

therefore, how are they administered

A

concentration

at a HIGH DOSE once daily

ie: gentamicin is 5-7mg/kg Q24H instead of 1-2mg/kg Q8H

51
Q

aminoglycosides are conc dependent killing and thus give higher doses less frequently

give specific EX with amikacin

A

15mg/kg Q24H instead of 7.5mg/kg Q12H

52
Q

3 benefits of administering aminoglycosides Q24H instead of more frequently

A

easier to administer

easier drug monitoring

decreased nephrotoxicity of aminoglycosides

53
Q

give 2 secnarios when we may use combination therapy to broaden the spectrum of coverage

A

-mixed infection
-nosocomial infection

54
Q

3 ex when we may use combination antimicrobial therapy

A

-broaden spectrum
-synergy
-prevent resistance

55
Q

give an example of combination therapy for enterococcal endocarditis

A

beta lactam + aminoglycoside

gives more RAPID KILLING - SYNERGY

56
Q

true or false

combination antimicrobial therapy can be used to prevent resistance

A

true

57
Q

4 disadvantages of combination antimicrobial therapy

A

-superinfection risk
-toxicities
-antagonist
-cost

58
Q

when monitoring the therapeutic response to antibiotics, _____________ improvement may lag

A

radiologic

59
Q

do we repeat chest x rays to check for therapeutic response improvement

A

NO - only if pt not improving

60
Q

give 2 ab’s where we do therapeutic drug monitoring

A

vancomycin or aminoglycosides

61
Q

4 scenarios when we can do IV-PO switch

A

-overall clinical improvement

-no fever for 24 hrs

-decreased WBC

-functioning GI tract

62
Q

true or false

IV to PO switch does not decrease infection rates

A

FALSE - it does

there’s no open IV line

63
Q

1st 2nd and 3rd line for HOSPITAL ACQUIRED MRSA

also, name how they come

which has interaction with statin and can increase CPK (creatinine phosphokinase)

A

vancomycin (IV and PO, but PO only for c diff)

linezolid (PO and IV)

daptomycin (NOT FOR LUNGS) (IV only)

dapto

64
Q

what is the ONLY cephalosporin with MRSA coverage

A

Ceftaroline (5th gen)

65
Q

name 3 main ABs mainly used for community acquired MRSA (not hospital)

A

bactrim
clindamycin
doxycycline

66
Q

does ceftaroline have pseudomonas coverage

A

NO

has MRSA coverage tho

67
Q

“cousin” of linezolid that has less thrombocytopenia issues and no DDI with SSRIs

A

tedizolid

68
Q

2 “cousins” of vanco that are very long acting glycopeptides (1-2 weeks)

A

dalbavancin
oritavancin

69
Q

true or false

tigecyciline does not have MRSA coverage

A

FALSE - it does

70
Q

fluoroquinolone not really used but has MRSA coverage and pseudomonas coverage

A

delafloxacin

71
Q

differentiate between intrinsic and acquired resistance and give ex

A

intrinsic - vanco has always and will always be ineffective against gram negative, cephalosporins will never work against enterococcus

acquired - due to inappropriate abx use (ie: decreased permeability, efflux pump, drug inactivation, altered target)

72
Q

drug of choice for MRSA and 3 alternatives

A

vancomycin

daptomycin, linezolid, and ceftaroline

73
Q

what is VRE and explain it

what are drugs of choice

A

vancomycin resistant enterococcus

altered target site
D-alanyl-D-alanine switched to D-alanyl-D-lactate

linezolid and daptomycin are drugs of choice

74
Q

what are ESBLs and what are the drugs of choice

A

extended spectrum beta lactamases - they hydrolyze the beta lactam ring and inactivate most beta lactams (penicillin, cephalosporin, and monobactam)

CARBAPENEMS are drug of choice

75
Q

ESBLs are produced by gram positive or negative bacteria

A

NEGATIVE

76
Q

what are CREs

A

carbapenem resistant enterobacterales

produce carbapenamases that inhibit ALL BETA LACTAMS - INCLUDING CARBAPENEMS

77
Q

drugs of choice for CREs

A

tailored to whatever is most susceptible, but there’s

polymyxin, ceftazidime/avibactam, meropenem/vaborbactam
(newer beta lactams)

78
Q

primary and secondary goal of antimicrobial stewardship

A

primary - optimize clinical outcomes while minimizing unintendend consequences (c diff diarrhea, resistance)

secondary - decrease healthcare costs

79
Q

antimicrobial stewardship was a mandate made by _______-

A

the joint commission

80
Q
A

D&D Infectious Disease Midterm (26 decks)

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