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64 Cards in this Set
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MOA penicillins
what all is included? |
block cell wall synthesis by inhibition of peptidoglycan cross-linking
penicillin, ampicillin/amoxicillin; augmentin, unasyn; ticarcillin/piperacillin; timentin, zosyn; IV nafcillin, oxacillin; PO dicloxacillin |
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penicillin DOC
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group a strep
confirmed penicillin sensitive: pneumonoccal infxn- pneumonia, meningitis confirmed penicillin sensitive: meningococcal infxn syphilis = treponema pallidum |
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if you give a penicillin shot to someone with really bad syphillis and he goes red systemically, what is it
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Jarish-Herxheimer reaction form endotoxin like products released by dead treponema
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ampicillin/amoxicillin DOC
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broader spectrum, general minor infxn:
acute sinusitis, otitis which are usually frrom pneumococcus, H flu, moraxella catarrhalis ampicillin for listeria (meningitis in babies and elderly). Often covers enterococcus NOT: bronchitis except if COPD pt |
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persistent minor infxn- persistent sinusitis or otitis
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Augmentin: amoxicillin and beta lactamase inhibitor
often doesn't cover pneumococcus resistance (altered binding = resistance) cefuroxime (IV): 2nd gen cephalosporin |
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mixed infxn like diabetic foot ulcer that doesn't have MRSA
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Unasyn (IV): ampicillin and beta-lactamase inhibitor
ciprofloxacin |
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pt has bronchitis- coughing yellow sputum
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no abx
unless COPD pt- give them ampicillin/amoxicillin |
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GAS DOC
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penicillin
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acute sinusitis/otitis
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ampicillin/amoxicillin
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persistant pneumococcal infxn
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raise the dose of antibiotics. Resistance is from drug binding the bacteria uses so.
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anti-pseudomonas penicillin
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ticarcillin/piperacillin
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burn pts infxn MCC
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pseudomonas
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neutropenic pt
HAP pt CF pt MCC infxn |
pseudomonas
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why are pts neutropenic
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chemotherapy
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critically ill hospital acquired infxn, suspect pseudomonas
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timentin: ticarcillin and beta lactamase inhibitor (have to chase with 1L of saline)
zosyn: piperacillin and beta lactamase inhibitor (often use higher dose) avoid ceftazidime since induces BLase cefepime |
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pt has cellulitis MCC and DOC
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staph aureus (non-MRSA)- IV Nafcillin or oxacillin, or PO dicloxacillin
cefazolin for minor outpt style if deep tissue- fasciitis clindamycin (bacteriostatic to keep from blowing it up) |
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pt has endocarditis MCC DOC
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staph aureus: IV Nafcillin or oxacillin, or PO dicloxacillin
may add an aminoglycoside: synergizes against beta-lactamase bad situation: daptomycin |
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MRSA
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non-serious soft tissue: bactrim clindamycin vancomycinlinezolid daptomycin (not if pneumonia) |
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cephalosporins include
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cefazolin
cefuroxime cefotaxime, ceftriaxone, ceftazidime, cefixime, cefdinir cefepime |
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pneumococcal meningitis, not penicillin susceptible
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third gen cephalosporins: cefotaxime, ceftriaxone, ceftazidime, cefixime, cefdinir
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what all do cephalosporins cover in general
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gram + to gram - in later gens
not enterococcus doesn't cover most anaerobes |
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pseudomonas- allergic to penicillins
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ceftazidime - induces beta-lactamase so cefepime preferred
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cephalosporins promote bacterial resistance - how and in what species (name 7)
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extended spectrum beta lactamase gram-
Klebsiella, actinobacter, enterobacter, proteus, pseudomonas, serratia, e.coli |
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pre-operative prophylaxis
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cefazolin (1st gen cephalosporin)
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outpt cellulitis, minor staph infxn
well, maybe it's MRSA |
cefazolin (IV) 1st gen cephalosporin
bactrim, clindamycin |
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in ICU pt super sick, what abx going to avoid
what abx probably going to use |
3rd gen cephalosporins- induce the ESBL gram-
aminoglycosides |
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gram- infxn, very serious. tx?
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combo: ceftriaxone and tobramycin
aztreonam primaxin |
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aminoglycosides MOA
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block protein synthesis at 30S ribosomal unit
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aminoglycosides main target
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gram- infxn
not for lungs or meninges |
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aminoglycosides include
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gentamicin
tobramycin amikacin |
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aminoglycosides AE
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renal toxicity, ototoxicity
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macrolides MOA
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23S rRNA of 50S ribosomal unit
bacteriostatic |
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macrolides AE
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motilin stimulation, feel nausea in erythomycin though gastroparesis is helped with it
prolonged QT |
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macrolides include
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erythromycin
azithromycin, clarithromycin |
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walking pneumonia: MCC DOC
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mycoplasma: erythromycin
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legionella
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macrolide: erythromycin resistance increasing, azithromycin better
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uncomplicated CAP
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used to be macrolides but used Z pack too much so now have to be more careful
doxycycline levofloxacin |
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immunocompromised pt has pneumonia- looks like pneumocystis jiroveci
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bactrim
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bactrim: what's in it and MOA
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trimethoprim-sulfamethoxazole- blocks nucleotide synthesis by inhibiting bacterial folate synthesis
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bactrim uses
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all around: gram+ gram-
minor infxn: otitis, sinusitis uncomplicated UTI/cystitis unclear tho- building resistance NOT for strep throat, pseudomonas, anaerobes |
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bactrim AE
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rash, stevens johnson syndrome, hemolysis with G6PD deficiency pt
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UTI with E.coli sulfa resistance tx
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nitrofurantoin
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nitrofurantoin AE
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pulm toxicity
acute hypersensitivity chronic pulm interstitial dz urine brown |
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UTI in pregnant woman tx
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nitrofurantoin
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tetracyclines MOA and includes
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inhibits 30S ribosomal subunit
doxycycline |
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chlamydia tx
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doxycycline maybe with ceftiraxone (called zithromax) which then covers gonorrhea too (often co-infxn)
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spring/summer
fever low WBC platelets elevated transaminases dx? |
Rickettsiae dz
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Rickettsiae dz includes
DOC |
rocky mountain spotted fever
erlichiosis anaplasmosis doxycylcine |
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quinolones MOA and includes
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inhibit DNA gyrase and topoisomerase
ciprofloxacin levofloxacin |
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what does ciprofloxacin cover
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PO broad spectrum= kills everything except pneumococcus (which is super common)- in that case use levofloxacin
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complicated UTI or prostatis
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cipro
resistant UTI: nitrofurantoin |
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AE of quinolones
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achilles tendon rupture
CNS- not for myasthenia gravis pt |
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when do we use clindamycin
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anaerobic infxn-
necrotizing fasciitis with strep or staph, MRSA. Bacteriostatic so. |
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C. diff enterocolitis
trichomonas giardia |
metronidazole
c. diff- also vancomycin |
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how does metronidazole work
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a nitroimidazole, unclear mechanism but ups free radicals in microbe
Cannot drink alcohol on this |
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how does vancomycin work
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inhibits cell wall synthesis- a glycopeptide. Not susceptible to beta lactamase
covers intense staph infxn and enterococcal (pyelonephritis- but then tricky because nephrotoxicity chance) |
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vancomycin AE
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nephrotoxicity, ototoxicity; red man syndrome
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aztreonam
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mega gram- for serious infxn
use if penicillin allergic pt |
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carbapenems- what does it include
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primaxin
meropenem ertopenem |
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what do you use carbapenems for
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all around IV drug for serious infxn that are resistant
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bug is bad infxn and is resisting other drugs
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vancomycin: staph, enterococcal, C. diff
aztreonam: gram- carbapenem: all around IV, ESBL gram- linezolid: gram+ VRE (enterococcus) MRSA PRSP (strep pneumo) daptomycin: MRSA cellulitis, bacteremia, endocarditis; NOT MRSA pneumonia |
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AE of carbapenem
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seize
renal failure |
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linezolid AE to watch for
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peirpheral neuropathy
myelosuppression MAO inhibitor |
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uses for daptomycin
AE concern |
MRSA, bacteremia, endocarditis
Not pneumonia MRSA though- surfactant disables it. Risk of eosinophilic pneumonia. |
