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155 Cards in this Set
- Front
- Back
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what makes a bacteria gram +?
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thick cell wall
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3 classes of gram positive cocci
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streptococci (strings)
staphylococci (grapes) enterococci |
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3 types of streptococci
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S. pneumoniae
Group B streptococci Viridans streptococci |
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2 types of staphylococci
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S. aureus
coag-negative Staph (e.g. staph epidermidis) |
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2 types of enterococci
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E. faecalis
E. faecium |
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gram negatives are typically which two shapes
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rods
cocci |
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5 gram negative rods
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E. coli
K. pneumoniae H. influenzae P. aeruginosa SPACE |
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SPACE bugs
(double-covered gram negative rods) |
Serratia
Pseudomonas Acinetobacter Citrobacter Enterobacter |
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3 gram negative cocci
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M. catarrhalis
N. gonorrhoeae N. meningitidis |
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what makes an atypical respiratory aerobe
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don't gram stain because they're intracellular pathogens
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3 atypical respiratory aerobes
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Legionella
Mycoplasma pneumoniae Chlamydia pneumoniea |
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2 true anaerobes
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gut!
Bacteroides fragilis Clostridium difficile (diarrhea) |
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2 oral anaerobes
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facultative anaerobes, easier to cover than true anaerobes
Prevotella Peptostreptococcus |
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MRSA is actually resistant to
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penicillins
cephalosporins |
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DoC for MRSA is
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vancomycin
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MoA of penicillins
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inhibit cell wall synthesis
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MoR of penicillins
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-beta lactamases
-altered PBPs |
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5 subclasses of penicillin
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natural
amino penicillinase resistant extended spectrum combo |
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natural penicillin is DOC for
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N. meningitidis
syphilis |
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natural penicillin covers which gram positive organisms
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streptococci
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natural penicillin covers which gram negative organisms
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none
except (N. meningitidis, syphilis? G- cocci?) |
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natural penicillin covers which anaerobes
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oral only
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2 aminopenicillins
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ampicillin
amoxicillin |
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aminopenicillins often used for
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respiratory infections
(DoC for enterococci) |
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aminopenicillins covers which gram positive organisms
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strep
enterococci |
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aminopenicillins covers which gram negative organisms
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some (E. coli, H. flu +/-)
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aminopenicillins covers which anaerobes
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oral
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2 penicillinase resistant penicillins
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dicloxacillin
nafcillin |
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penicillinase resistant penicillins are the DOC for
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MSSA
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penicillinase resistant penicillins cover which gram positive organisms
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strep
MSSA |
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penicillinase resistant penicillins cover which gram negative organisms
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none
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penicillinase resistant penicillins cover which anaerobes
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oral
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2 extended spectrum penicillins
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piperacillin
ticarcillin |
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extended spectrum penicillins are used for
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severe infections (broad spectrum)
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extended spectrum penicillins cover which gram positive organisms
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strep
staph entero? |
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extended spectrum penicillins cover which gram negative organisms
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E. coli
Kleb Pseudomonas aerigunosa |
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extended spectrum penicillins cover which anaerobes
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oral
some true |
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function of beta-lactamase inhibitors
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increase MSSA coverage
enterobacteriaceae anaerobes |
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BL/BLI combos cover which gram positive organisms
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Strep
MSSA eneterococci |
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BL/BLI combos cover which gram negative organisms
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excellent, but doesn't change/add coverage of P. aeruginosa
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2 common adverse reactions of penicillins
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allergic (anaphylaxis, rash, urticarea, fever)
diarrhea |
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4 less common adverse reactions with penicillins
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hematologic
-anemia, thrombocytopenia hepatitis/biliary - naf/ox interstitial nephritis - naf/ox seizures - high doses |
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monitoring of penicilins
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renal dosing due to renal clearance (NOT naf/ox/dicloxacillin due to biliary excretion)
toxicity |
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1st generation cephalosporins
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cefazolin
cephalexin |
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uses of 1st generation cephalosporins
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skin infections
some respiratory infections |
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all cephalosporins cover which gram positive organisms
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Strep
MSSA NEVER MRSA enterococcus ceftazidime has little to no gram positive coverage |
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all cephalosporins cover which gram negative organisms
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E. coli
Kleb |
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all cephalosporins cover which anaerobes
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oral
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2nd generation cephalosporins
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cefuroxime
cefotetan cefoxitin |
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use of 2nd gen cephalosporins
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surgery Px (GI infxns)
some respiratory (oral) |
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2nd gen cephalosporins cover which gram posititive bugs
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Strep
MSSA |
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2nd gen cephalosporins cover which gram negative bugs
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E. coli
Kleb H. flu |
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2nd gen cephalosporins cover which anaerobes
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oral
B frag |
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3rd gen cephalosporins
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ceftriaxone
cefotaxime ceftazidime |
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use of 3rd gen cephalosporins
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respiratory infections
(Strep pneumo) serious infections |
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3rd gen cephalosporins cover which gram posititive bugs
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Strep
MSSA |
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3rd gen cephalosporins cover which gram negative bugs
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ALL
E. coli Kleb H. flu Pseudomonus aeruginosa |
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3rd gen cephalosporins cover which anaerobes
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oral
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4th generation cephalosporin
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cefepime
(like cefazolin + ceftazidime) |
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4th generation cephalosporins cover which gram positive bugs
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strep
MSSA |
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4th generation cephalosporins cover which gram negative bugs
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ALL
E. coli Kleb H. flu Psuedomonas aeruginosa |
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4th generation cephalosporins cover which anaerobic bugs
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oral
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common ADRs with cephalosporins
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allergic reaction
diarrhea |
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rare ADRs with cephalosporins
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allergies (carbapenems)
anemia thrombocytopenia seizures (carbapenems) |
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monitoring for cephalosporins
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renal dosing (except ceftriaxone - biliary excretion)
toxicity |
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4 carbapanems
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imipenem
meropenem ertapenem doripenem |
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use of carbapenems
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severe infections, broad spectrum
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MOA of carbapanems
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inhibits cell wall synthesis
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MOR of carbapenems
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β-lactamases
outer membrane protein mutations |
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carbapenems cover which gram positive bugs
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strep
MSSA |
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carbapenems cover which gram negative bugs
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ALL
except ertapenem doesn't cover Pseudomonas |
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carbapenems cover which anaerobes
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Oral
B. frag |
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1 monobactam
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aztreonam
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Use of monobactams
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if PCN allergy
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MOA of monobactams
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inhibits CW synthesis
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MOR of monobactams
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β-lactamases
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monobactams cover which gram positive bugs
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none
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monobactams cover which gram negative bugs
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All
E. coli Kleb H. flu Pseudomonas |
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monobactams cover which anaerobes
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none
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3 aminoglycosides
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gentamicin
tobramycin amikacin |
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use of AGs
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severe (gram negative) infections
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MOA of AGs
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inhibits ribosomal protein synthesis
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MOR of AGs
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inactivating enzymes
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4 FQs
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cipro
levo moxi gemi |
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uses of FQs
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atypical respiratory pathogens
Legionella Chlamydia pneumoniae Mycoplasma pneumoniae |
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MOA of FQs
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inhibit DNA synthesis via DNA gyrase and topo IV
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MOR of FQs
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mutations at target sites
efflux pumps that pump drugs out of bacteria |
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FQs cover which gram positive bugs
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Strep
MSSA (not cipro) |
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FQs cover which gram negative bugs
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ALL
E. coli Kleb H. flu Pseudo |
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FQs cover which anaerobes
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variable
minimal oral > BF |
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Common ADRs with FQs
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CNS
-HA -dizziness, -insomnia |
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rare ADRs with FQs
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-cartilage toxicity
-↑QT |
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FQs are contraindicated in which populations?
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pregnancy
children |
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monitoring of FQs
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-renal function
-DI’s with cations -toxicity |
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3 macrolides
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erythromycin
clarithromycin azithromycin |
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use of macrolides
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atypical respiratory pathogens (Legionella, Chlamydia pneumoniae, Mycoplasma pneumoniae)
same as FQ |
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MOA of macrolides
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ribosome protein synthesis inhibitor
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MOR of macrolides
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mutations at ribosomal target sites
efflux pumps that pump drugs out of bacteria |
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macrolides cover which gram positive bugs
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Strep
Some MSSA |
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macrolides cover which gram negative bugs
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H. Flu (clarithro)
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macrolides cover which anaerobes
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oral
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common ADRs of macrolides
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-GI (N/V/D)
-Phlebitis |
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rare ADRs of macrolides
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-↑QT
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monitoring for macrolides
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-renal dosing
-CYP450 inhibitor -toxicity |
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2 anti-anaerobes
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metronidazole
clindamycin |
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MOA of metronidazole
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free radicals
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MOR of metronidazole
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rare
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metronidazole covers which gram positive bugs
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none
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metronidazole covers which gram negative bugs
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none
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metronidazole covers which anaerobes
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oral
B. frag |
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common ADRs with metronidazole
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Nausea
metallic taste |
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MOA of clindamycin
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ribosomal protein synthesis inhibitor
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MOR of clindamycin
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mutations on ribosomes
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clindamycin covers which gram positive bugs?
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Strep
MSSA |
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clindamycin covers which gram negative bugs?
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none
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clindamycin covers which anaerobes
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oral
B frag (OK) |
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Common ADRs of clindamycin
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-D, C. difficile
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metronidazole and clindamycin require what type of monitoring
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toxicity
NOT RENALLY DOSED |
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2 drugs used for gram positive drugs
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vancomycin
linezolid |
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MOA of vancomycin
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inhibits cell wall synthesis
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MOR of vancomycin
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altered cell walls
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Use of vancomycin
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DOC for MRSA
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vancomycin covers which gram positive drugs
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ALL
Strep MSSA MRSA Entero |
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vancomycin covers which gram negative drugs
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none
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vancomycin covers which anaerobes
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G+ oral only
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ADRs of vancomycin
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-“red man”
-NTX -ototoxicity |
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monitoring of vancomycin
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wt/renal dosing
concentration |
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MOA of linezolid
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ribosome protein synthesis inhibitor
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Use of linezolid
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DOC for VRE
2nd for MRSA serious infections |
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linezolid covers which gram positive drugs
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Strep
MSSA MRSA Entero |
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linezolid covers which gram negative drugs
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none
(H. flu) |
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ADRs of linezolid
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-thrombo-cytopenia
-anemia -neutro. |
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monitoring for linezolid
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CBC
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MOA of SMX/TMP
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inhibits folic acid synthesis via enzyme inhibition
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MOR of SMX/TMP
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alterations in target enzymes
|
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SMX/TMP covers which G+
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Strep
MSSA |
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SMX/TMP covers which G-
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Enterobacteriacae
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SMX/TMP covers which anaerobes
|
oral
|
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SMX/TMP ADRs
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-allergy
-GI -neutropenia -thrombocytopenia |
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SMX/TMP monitoring
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**increases effects of warfarin
toxicity |
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3 tetracyclines
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tetracycline
doxycycline minocycline |
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use of tetracyclines
|
atypical respiratory pathogens
|
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MOA of tetracyclines
|
ribosome protein synthesis inhibitor
|
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MOR of tetracyclines
|
efflux pumps
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tetracyclines cover which Gram +
|
Strep
MSSA |
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tetracyclines cover which Gram -
|
H. flu
|
|
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tetracyclines cover which anaerobes
|
oral
|
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tetracycline ADRs
|
-photosensitivity
-N/D -tooth discolor’n in kids |
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tetracycline monitoring
|
chelation with cations
toxicity |
|
|
drugs that cover pseudomonas
|
-AGs
-cipro/levo -ceftazidime/cefepime -piperacillin/ticarcillin -aztreonam -carbapenems (not erta) |
|
|
drugs that cover MRSA
|
vancomycin
linezolid daptomycin tigecycline |
|
|
drugs that have true anaerobic coverage
|
metronidazole
BL/BLIs carbapenems -------------------------- clindamycin cefoxitin/cefotetan |
|
|
Normal Peripheral WBC counts
|
6000 total
0 bands 60 neutrophils 20 lymphocytes 10 monocytes |
|
|
Left Shift WBC counts
|
10 bands
70 neutrophils 10 lymphocytes 2 monocytes |
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4 sterile sites that should not contain WBCs or pathogens
|
spinal fluid
blood joint fluid urine |
