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Medical Microbiology > Therapy for Staph and Strep II > Flashcards

Therapy for Staph and Strep II Flashcards

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USMLE® Step 1 flashcards Biology 101 flashcards
1
Q

What type of compound is vancomycin?

A

Glycopeptide

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2
Q

Vancomycin mechanism of action?

A

Prevents cell wall synthesis, binds to d-ala-d-ala, prevents elongation and cross linking.

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3
Q

Resistance to vancomycin?

A

D-Ala-D-Ala turned into D-Ala-D-Lactate, Vanco can’t bind. Also, thickened cell wall.

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4
Q

What types of organisms does vancomycin affect?

A

Only gram positive organisms

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5
Q

Is vancomycin bactericidal or bacteriostatic?

A

Slowly bactericidal, but bacteriostatic against enterococci

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6
Q

What is vancomycin the drug of choice to treat?

A

MRSA and penicillin-resistent pneumococcus

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7
Q

Why is the oral formulation used to treat C. diff?

A

Because it isn’t absorbed, so it doesn’t work systemically, only in gut lumen.

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8
Q

Toxicity of vancomycin?

A

Nephrotoxicity, hypersensitivity (red man syndrome).

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9
Q

Red Man syndrome

A

Histamine response to rapid vanco infusion. Huge widespread rash.

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10
Q

What type of compound is daptomycin?

A

A cyclic lipopeptide

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11
Q

What type of organisms does daptomycin treat?

A

Gram positive organisms (MRSA, MSSA, Enterococci, VRE). NO gram negative activity

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12
Q

VRE

A

Vancomycin resistent enterococci.

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13
Q

Does daptomycin have gram negative activity?

A

No!

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14
Q

How does daptomycin work?

A

Binds to the cytoplasmic membrane using Ca and causes rapid depolarization, leading to intracellular ion release. Rapid bactericidal action, concentration dependent mechanism.

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15
Q

What type of infections is daptomycin used for?

A

Skin and soft tissue infections. MSSA, MRSA, bloodstream infections. VRE.

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16
Q

What isn’t daptomycin used for pneumonia?

A

It is inactivated by pulmonary surfactant.

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17
Q

Adverse effects of daptomycin

A

Musculoskeletal pains, weakness, rhabdomyolysis

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18
Q

Who is at increased risk for rhabdomyolysis when taking daptomycin? What to do to monitor?

A

Those on statins! Check CPK (creatine phosphokinase) levels and monitor muscle strength.

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19
Q

Inhibitors of protein synthesis in gram positive cocci

A

Linezolid, doxycycline, clindamycin. These drugs are bacteriostatic.

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20
Q

Inhibitors of protein synthesis

A

Linezolid, Doxycycline, Clindamycin. These drugs are bacteriostatic.

21
Q

What type of compound is doxycycline?

A

A tetracycline

22
Q

What organisms does doxycycline treat?

A

Gram positive and gram negative bacteria, also useful against INTRACELLULAR BACTERIA

23
Q

What is doxycycline used for?

A

Skin and soft tissue infections

24
Q

Where is doxycycline absorbed?

A

In the GI tract

25
Q

What is something tricky about taking doxycycline?

A

Avoid dairy, forms nonabsorbable chelates with Ca, Mg, Fe, Al

26
Q

Where does doxycycline concentrate?

A

In the liver, kidney, skin, and spleen. Large Vd.

27
Q

Adverse effects of doxycycline?

A

Binds to calcifying tissues like teeth and bones. GI discomfort, hepatoxicity, photosensitivity.

28
Q

Metabolism of Doxycycline

A

Hepatic metabolism, renal excretion

29
Q

What can clindamycin treat?

A

Potentially active against strep and staph. Anaerobic bacteria and non-enterococcal gram positive cocci. NO activity against enterococcus

30
Q

Does clindamycin reach therapeutic levels in CSF/urine?

A

No.

31
Q

Side effects of clindamycin?

A

Rash – potentially C.Diff

32
Q

How to treat enterococcus?

A

Penicillin/ampicillin. Vancomycin (most is susceptible)

33
Q

How to treat vancomycin resistant enterococci?

A

Linezolid

34
Q

What is special about linezolid?

A

100% bioavailability, so oral is great.

35
Q

Problems with prolonged use of linezolid?

A

Thrombocytopenia and neuropenia, lactic acidosis, serotonin syndrome when taken with SSRIs.

36
Q

Serotonin syndrome

A

Cognitive: Mental status changes
Autonomic: fever, hypertension, tachycardia
Somatic: hyperreflexia, myoclonus, tremor

37
Q

Folic Acid antagonists

A

Trimethoprim-Sulfamethoxazole (TMP-SMZ, bactrim)

38
Q

Why is folate important?

A

Needed to synthesize DNA, RNA

39
Q

Is TMP-SMZ bactericidal or bacteriostatic?

A

Bacteriostatic

40
Q

What is TMP-SMZ used to treat?

A

MRSA/MSSA, but primarily UTIs, also treats listeria in the setting of beta lactam allergy.

41
Q

Where is TMP-SMZ absorbed?

A

Intestines, large Vd including CSF

42
Q

Why isn’t TMP-SMZ given to neonates?

A

Causes kernicterus (bilirubin deposition, causes movement disorders and developmental delays).

43
Q

What is the drug of choice for MRSA?

A

Vancomycin

44
Q

What is rapidly bactericidal and can be used for strep and staph infections, but not pneumonia?

A

Daptomycin

45
Q

What is potentially active against strep and staph?

A

Clindamycin

46
Q

What should not be given to children or pregnant women?

A

Doxycycline

47
Q

What is associated with many side effects, so patients must be monitored closely?

A

Linezolid

48
Q

What drug does not have reliable streptococcal coverage?

A

TMP-SMZ

Medical Microbiology (29 decks)

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