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421 Cards in this Set
- Front
- Back
Name the Antibacterial agents that act by inhibiting cell wall synthesis?
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Penicillins, Cephalosporins, Vancomycin & Nitrofurantoin
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Name the antibacterial agents that act by inhibiting protein synthesis at the 50s Ribosome.
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50s Ribosome: Macrolides, Ketolides, clindamyacin, oxanolidinones, streptogramins
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Name the antibacterial agents that act by inhibiting protein synthesis at the 30s Ribosome.
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Tetracyclines, Glycyclcyline, Aminoglycosides
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Name the antibacterial agents that act by inhibiting nuclein acid synthesis.
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Fluoroquinolones
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Name the antibacterial agents that act by inhibiting folic acid synthesis.
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Sulfamethoxazole, trimethoprim
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what antibiotics at to inhibit cell wall synthesis??
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B-lactams, Cephalosporins, Cabapenems, Vancomycin
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Where does Metronidazole work?
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Inhibits DNA replication
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Where do Fluoroquinolones work?
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Inhibit Topoisomerases
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Where does Rifampin work?
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Inhibits RNA transcription
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Where do Sulfonamides work?
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Inhibit Nucleotide biosynthesis.
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Name the four groups of penicillins
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1. Natural Penicillins
2. Aminopenicillins 3. Penicillinase-resistant Penicillins 4. Extended spectrum Penicillins |
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Which NATURAL penicillin is the only one that can be used orally?
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Penicillin V potassium a.k.a Pen Vee K
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Name the natural penicillins that are used through IV administration.
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Penicillin G Sodium or Penicillin G Potassium
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Which natural penicillins are used in an extended injextion/ depot form?
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Procain Penicillin & Benzathine Penicillin
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What is the major use for natural penicillins?
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LIMITED to known susceptible organisms, mild infectins and prophylaxis for dental treatments
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Natural Penicillins are the drug of choice in treatment of what organism?
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Treponema pallidum (Syphillis)
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Natural penicillins possess a___________ spectrum of activity.
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Limited
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Natural penicillins are effective against which gram + cocci?
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Gram + aerobic cocci (excep penicillinase producing strains)Streptocci (beta-hemolytic strep, viridans, group D strep, Streptococcus pneumoniae (if susceptible), enterococcus spp. (inhibited but not killed), some Staph aureus spp., Listeria, Bacillus anthracis
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Natural penicillins are effective against which gram - cocci?
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Neisseria meningitidis, some Neisseria gonorrhoeae, some strains of H. influenzae, and Pasteurella
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Natural penicillins work against these anaerobes...
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clostridium, fusobacterium, peptostreptococcus
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What are some of the unique cautions when using natural penicillins??
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*May be culprit of drug fever
*Jarisch-Herxheimer reaction: secondary to release of protein by syphyllis 1-12 hrs after administration (may see HA, chills, sore throat, sweating, mylagias, increase HR and BP, then hypotension. Resolves in 10-24 hrs. *Electrolyte disturbances: especially HYPERKALEMIA may occur in high doses particularly with renal dysfunction |
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Which natural penicillin injectible form is given less frequently? Penicillin G Procaine or Penicillin G Benzathine?
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Penicilline G Benzathine (Bicillin LA)is given as a 1 time dose and last 1-4 weeks
Penicillin G Procaine (Wycillin) is given every 12-24 hrs. Both are given IM |
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What is the average adult dose for Pen Vee K?
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250-500 mg PO q6h (25k-50k units/kg/d q 6-8h)
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Name the Aminopenicillins.
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Amoxicillin and Ampicillin
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Which aminopenicillin is only available orally?
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Amoxicillin
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True or False: Ampicillin is available PO and IV
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TRUE
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What spectrum of activity do aminopenicillins provide?
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NARROW-- Do provide broader coverage than Natural PCNs though
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What organism are aminopenicillins known to be very effective against?
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Streptococcus pneumoniae
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What is a benefit seen when using aminopenicillins?
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Effective against a few Gram - organism such as E.coli, Proteus mirabilis, Salmonella, Shigella (some resistance reported) compared to Natural Penicillins
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what are some major uses for Aminopenicillins??
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upper respiratory tract infections (otitis media), urinary tract infections, STDs, other infections with known susceptible organisms. Also used commonly for prophylaxis for dental procedures and in combination with other agents for treatment of H. pylori.
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Name two unique cautions when using aminopenicillins.
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*Rash is particularly common when give to patients w/ infections mononucleosis
*C.diff. colitis is more common w/ ampicillin that other Penicillins |
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True or false: Ampicillin has much buch better oral absorption than amoxicillin.
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FALSE: Ampicillin should never be given PO Give amoxicillin instead
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What are the Penicillinase producing organisms?
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HAMS:
Haemophilus influenzae Anaerobes-- Especially Bacteroides fragilis Moraxella catarrhalis Staphylococcus aureus,- epidermidis, saprophyticus ** ALSO Enterobacteriaceae (Proteus, Klebsiella pneumoniae, E. coli & Citrobacer) |
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What are the Penicillinase-resistant penicillins?? a.k.a. "anti-staphylococcal penicillins"
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Methicillin (IV)
Nafcillin (Unipen, Nafcil- IV) Oxacillin (Protaphlin- IV, PO) Dicloxacillin (Dynapen- PO) Cloxacillin (PO) |
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What spectrum do Penicillinase resistant penicillins have??
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NARROW!! Activity is limited to S. aureus & S. epidermidis and some strains of strep
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Penicilinase- resistant penicillins spectrum is reduced due to 2 things:
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1)No activity against gram negative organisms
2) Not active against MRSA (Methicillin resistant Staph Aureus) |
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True or False: if staphylococcus aureus is susceptible to oxacillin it will not be suseptible to cefazolin, clindamycin or erythromycin.
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False: Susceptibility is seen with all
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What are the major uses for Penicillinase-Resistant Penicillins?
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Treatment of infections known or suspected to be caused by Staphylococcus (cellulitis, endocarditis)
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Which Penicillinase- Resistant PCN has a unique caution for hepatotoxicity?
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OXACILLIN
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Which Penicillinase- Resistant PCN as a unique caution for phelbitis?
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NAFCILLIN-- also can cause sodium overload
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Which Penicillinase- resistant PCN can cause transient leukopenia?
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All
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What are the unique cautions with nafcillin??
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Phlebitis & Sodium overload--get 3.1 mEq of Na/gram of Naf.
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What is the unique feature of Extended spectrum penicillins? (structural)
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Alterations to the side chains results in greater activity against gram - (eg/ Pseudomonas) organisms compared with other agents
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What are the two major types of Extended- spectrum penicillins??
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1)Ureidopenicillins
2)Carboxypenicillins |
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Name the Ureidopenicillins.
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Piperacilin (PIPRACIL), Mezlocilin (MEZLIN), Azlocillin (Azlin)
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what is the spectrum of activity for Ureidopenicillins?
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BROAD--
*Wide spectrum of GRAM(-) coverage INCLUDING Pseudomonas!! *Better gram(-) coverage than animoPCNs (Enterobacters, Klebsiella) *Maintains activity agains some Gram(+)-- but is less than aminoPCNs |
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Name the Carboxypenicillins
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Carbenicillin (GEOPEN), Ticarcillin (TICAR)
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What is the spectrum of activity for Carboxypenicillins?
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BROAD- good Gram(-) coverage Not as active agains Pseudomonas as piperacillin
*Little activity agains gram(+) cocci including Staph, Strep & Enterococcus--Ureido works better |
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What is the disadvantage of Carboxypenicillins?
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Only available IV--> can be used in hospitalized patients
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Name the cautions that should be monitored w/ Carboxypenicillins
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1)Sodium-overload & HYPOkalemia w/ Ticarcillin (5.2 mEq Na/gm
2)Platelet dysfn w/ Ticarcillin 3)Seizures,HYPOmagnesemia & HYPOcalcemia w/ Carbenicillin 4)SJS 5)GI effects (esp w/ carbenicillin oral) also dry mouth, furry tongue, vaginitis |
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Name the cautions that should be monitored w/ Ureidopenicillins.
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1) Hepatitis
2)Have less Na+/g, less hypokaliemia, less platelet inhibition & greater hpatic excretion (vs renal) than Carboxypenicillins |
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A beta-lactamase inhibitor is sometimes referred to as a ________________?
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Suicide inhibitor
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How do Beta-lactamase inhibitor work?
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Ihibit beta-lactamases produced by bacteria--> preventing destruction of the antibiotic allowing more to bind to PBP
*Increases the spectrum of the abx vs betalactamase producers (HAMS & Enterobacteriacae) *DOES NOT work as an antibicrobial as itself!! |
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Name the beta-lactamase inhibitors & what they are effective against
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1)Clavulanate/Clavulanic acid--M. catarrhalis, B. fragilis, H. influenzae, Neisseria gonorrhea, Staph aureus
2)Sulbactam--N. meningitidis & gonorrhea, M. catarrhalis, Acinetobacter 3)Tazobactam--little antimicrobial activity of its own |
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Name the combination products available that combine Beta lactam & Beta Lacatamase Inhibitors
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*Amoxicillin/Clavulanic acid--Augmentin (PO
*Ampicillin/Sulbactam--Unasyn (IV) *Piperacillin/Tazobactam--Zosyn (IV) *Ticarcillin/Clavulanate--Timentin (IV) |
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What is Amoxicillin/Clavulanate Potassium (Augmentin) known to NOT be active against?
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Is not active against PCN resistant Strep. pneumoniae
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By combining amoxicillin w/ clavulanate potassium, greater efficacy is achieved vs which bugs? (8)
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1. Staph aureus
2. H. influenzae 3. M. catarrhalis 4. N. gonorrhoeae 5. E. coli 6. Proteus 7. Klebsiella 8. Bacteroides |
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Does taking Augmentin with food decrease absorption?
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No, it does not decrease absorption but DOES reduce the GI side effects
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What is Augmentin ES indicated for?
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Acute Otitis media due to Strep pneumoniae and B-lactamase producing strains of Haemophilus influenzae & Moraxella catarrhalis-- in children
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What is the ratio of Amoxicillin to Clavulanate Potassium in Augmentin and Augmentin ES?
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Augmentin--4-7:1
Augmentin ES 14:1 |
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Is the incidence of diarrhea with Augmentin ES increased, decreased or similar to regular Augmentin?
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Similar to regular Augmentin formulation
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What is Augmentin XR indicated for?
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Indicated for use in treating community acquired pneumonia, bronchitis or sinusitis in which a higher amount of amoxicilin would be needed to eradicate the causative microorganism.
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How much Amoxicillin and Clavulanate do each Augmentin XR tablet have?
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Amoxicillin: 1000mg
Clavulanate: 62.5 Regular Augmentin has 125mg of Clavulanate |
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What is the adult dose of Augmentin XR?
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Two tablets q12h (Total 4g/250mg daily)
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What would be a key counselling point for patients taking Augmentin XR?
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Be advised to take with meal or snack-- enhances absorption of amoxicillin and helps to minimize the possiblitiy of GI upset
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The added uses of Ampicillin/Sulbactam (Unasyn)and Augmentin are...? (5)
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1)Intra-abdominal infections
2)gynecological infections 3)community acquired pneumonia 4)Animal or human bites 5)Diabetic foot ulcers |
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When covering against Pseudomonas list the ranking order of Betalactamase inhibitor antibiotics...
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PIPERCILLIN (Ureidopcn)
Mexlocillin (Ureidopcn) Azlocillin (Ureidopcn) Ticarcillin (Carboxypcn) Carbenicillin (Carboxypcn) |
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What are the added uses for Zosyn & Timentin??
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Coverage of Piperacillin & Ticarcillin alone PLUS: Beta-lactam producing organism (Mostly gram negatives) and anaerobes
** IS USED FOR SERIOUS INFECTIONS when broad spectrum coverage is required |
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What serious infections are commonly treated w/ Zosyn or Timentin?
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Nosocomial infections, polymicrobial infections & diabetic foot
** Is no advantage for gram (+) infection versus other alternatives or for PSEUDOMONAS as a single pathogen |
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When considering PCN as a treatment option what are some things to keep in mind?
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*Many pcn derivatives are destroyed by gastric acid & must be administered IV
*Generally have short t1/2 & require frequent administration *Primarily eliminated by the kidney--> good urine concentrations but need to be adjusted in renal dysfunction |
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what is Probenecid used for?
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Is given to decrease renal elimination & increase serum concentrations
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What are the common Adverse Effects or reactions seen w/ PCN?
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1)Allergic rxn: rash/urticaria, anapylaxis, drug fever or serum sickness
2)GI: n/v/d, pseudomembranous colitis 3)Renal: Interstitial nephritis (after large doses esp PCN or Ampicillin) 4)Neurological (w/ high doses): Irritability, confusion, myoclonic jerk, visual, seizures 5)Hematoligic: thrombocytopenia, hemolytic anemia, granulocytopenia, eosinophilia (after course >7d) 6)Venous irritation at injxn site |
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What drug group has to be "challenged" if there is a suspected allergic reaction to penicillin?
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Cephalosporin
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What drug reaction commonly seen w/ Ampicillin when taken in conjunction w/ ALLOPURINOL?
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Increased frequency of rash
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What is the potential drug reaction seen when oral contraceptives are taken with either ampicillin or oxacillin?
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Decreases effect of antibiotic
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Is the incidence of diarrhea with Augmentin ES increased, decreased or similar to regular Augmentin?
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Similar to regular Augmentin formulation
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What is Augmentin XR indicated for?
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Indicated for use in treating community acquired pneumonia, bronchitis or sinusitis in which a higher amount of amoxicilin would be needed to eradicate the causative microorganism.
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How much Amoxicillin and Clavulanate do each Augmentin XR tablet have?
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Amoxicillin: 1000mg
Clavulanate: 62.5 Regular Augmentin have 125mg of Clavulanate |
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What is the adult dose of Augmentin XR?
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Two tablets q12h (Total 4g/250mg daily)
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What would be a key counselling point for patients taking Augmentin XR?
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Be advised to take with meal or snack-- enhances absorption of amoxicillin and helps to minimize the possiblitiy of GI upset
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The added uses of Ampicillin/Sulbactam (Unasyn)and Augmentin are...? (5)
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1)Intra-abdominal infections
2)gynecological infections 3)community acquired pneumonia 4)Animal or human bites 5)Diabetic foot ulcers |
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When covering against Pseudomonas list the ranking order of Betalactamase inhibitor antibiotics...
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PIPERCILLIN (Ureidopcn)
Mexlocillin (Ureidopcn) Azlocillin (Ureidopcn) Ticarcillin (Carboxypcn) Carbenicillin (Carboxypcn) |
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What are the added uses for Zosyn & Timentin??
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Coverage of Piperacillin & Ticarcillin alone PLUS: Beta-lactam producing organism (Mostly gram negatives) and anaerobes
** IS USED FOR SERIOUS INFECTIONS when broad spectrum coverage is required |
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What serious infections are commonly treated w/ Zosyn or Timentin?
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Nosocomial infections, polymicrobial infections & diabetic foot
** Is no advantage for gram (+) infection versus other alternatives or for PSEUDOMONAS as a single pathogen |
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When considering PCN as a treatment option what are some thing to keep in mind?
|
*Many pcn derivatives are destroyed by gastric acid & must be administered IV
*Generally have short t1/2 & require frequent administration *Primarily eliminated by the kidney--> good urine concentrations but need to be adjusted in renal dysfunction |
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what is Probenecid used for?
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Is given to decrease renal elimination & increase serum concentrations
|
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What are the common Adverse Effects or reactions seen w/ PCN?
|
1)Allergic rxn: rash/urticaria, anapylaxis, drug fever or serum sickness
2)GI: n/v/d, pseudomembranous colitis 3)Renal: Interstitial nephritis (after large doses esp PCN or Ampicillin) 4)Neurological (w/ high doses): Irritability, confusion, myoclonic jerk, visual, seizures 5)Hematoligic: thrombocytopenia, hemolytic anemia, granulocytopenia, eosinophilia (after course >7d) 6)Venous irritation at injxn site |
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What drug group has to be "challenged" if there is a suspected allergic reaction to penicillin?
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Cephalosporin
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What drug reaction commonly seen w/ Ampicillin when taken in conjunction w/ ALLOPURINOL?
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Increased frequency of rash
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What is the potential drug reaction seen when oral contraceptives are taken with either ampicillin or oxacillin?
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Decreases effect of abx
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How do Cephalosporins work?
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Work by inhibiting bacterial cell wall synthesis
-- classified at generations 1-4 |
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What is the known absorption/ pharmacokinetic property that makes cephalosporins advantageous?
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Excellent absorption from GI tract and penetrate well into tissues-- some even penetrate CSF
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Cephalosporins are TIME-DEPENDENT or CONCENTRATION DEPENDENT KILLERS?
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Time dependent bactericidal killers; must be administered in frequent intervals to maintain adequate concentrations above the MIC-- same as PCNs
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What are the 1st Generation ORAL Cephalosporins??
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Cephalexin (KEFLEX)
Cefadroxil (Duricef) |
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What are the 2nd Generation Oral Cephalosporins?
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Cefuroxime (Ceftin)
Cefprozil (Cefzil) Cefaclor (Ceclor) Loracarbef (Lorabid) |
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What are the 3rd Generation ORAL Cephalosporins?
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Cefposoxime (Vantin)
Ceftibuten (Cedax) Cefdinir (Omnicef) Cefditoren (Spectracef) |
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What are the 4th Generation ORAL Cephalosporins?
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THERE AREN'T ANY!!
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What are the 1st Generation IV Cephalosporins?
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Cefazolin (Ancef)
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What are the 2nd Generation IV Cephalosporins?
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Cefuroxime (ZINACEF)
Cefoxitin (MEFOXIN) |
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What are the 3rd Generation IV Cephalosporins?
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Ceftriaxone (Rocephin)
Ceftazinime (Fortaz) Cefotaxim (Claforan) |
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What are the 4th Generation IV Cephalosporins?
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Cefepime (MAXIPIME)
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What is the noticeable difference that is seen between Cephalosporin generations?
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As the generations increase, they lose gram (+) coverage except against Strep. pneumo. but they GAIN gram (-) coverage
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What coverage do the Cepholosporins have vs Entercoccus?
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NONE
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What generation of Cephalosporin is effective vs Pseudomonas?
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3rd (Ceftazinime) & 4th (Cefepime) generation only
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Which generation of Cephalosporin has greater coverage against Staph aureus? 1, 2, 3 or 4?
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1st ++++
2nd +++ 3rd ++ Ceftriaxone (ROCEPHIN) 4th ++ |
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Which generation of cephalosporin has the best coverage vs Strep. pneumo.?
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1st ++
2nd +++ **3rd ++++ Ceftriaxone (ROCEPHIN)** 4th +++ |
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What will 1st Generation Cephalosporins work against?
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Mostly Gram(+)-- Staph & Strep
Some Gram(-)-- such as Enterobacters; Proteus, E.coli, Klebsiella |
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What will 1st generation Cephalosporins NOT work against?
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WILL NOT WORK vs MRSA or Entercoccus, Listeria or atypical pneumonia pathogens such as Chlamydai pneumoniae, Mycoplasma pneumoniae and Legionella pneumopila
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What are oral cephalosporin agents commonly used for?
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Skin and soft tissue infections, UTI, respiratory tract infections (KEFLEX)
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What will 2nd Generation Cephalosporins be affective against?
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Improves Gram(-) coverage including H. influenzae and Enterobacters; Proteus, E.coli, Klebiella
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What are important features of Cefuroxime, Cefaclor and Cefprozil?
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Cefuroxime (CEFTIN), Cefaclor (Ceclor) & Cefprozil (Cefzil)-- 2nd Generation ORAL-->Retain the best coverage of Staph aureus while covering most Gram(-)'s
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What is Cefoxitin notably used for??
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Has increased activity against anaerobic bacteria (bacteroides) and is used in prophylaxis &/or treatment of intraabdominal infections
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What is notable about the 3rd Generation Cephalosporins vs Gram(+) bacteria?
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Cefotaxime and Ceftriaxone have best & similar coverage-- are active vs Methicillin susceptible staph & strep-- Including Strep. pneumo. and have good CSF penetration
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What is notable about the 3rd Generation Cephalosporins vs Gram(-) bacteria?
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Ceftazidime (Fortaz) covers Pseudomonas!! NO ORAL 3rd Generation has activity vs Pseudomonas
Oral 3rd generation have better Gram(-) coverage (Cefpodoxime (VANTIN) & Ceftibuten (CEDAX) are best) than oral 2nd Generations |
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What is the DOC for Meningitis?
|
Ceftriaxone (Rocephin) 3rd Generation IV Cephalosporin
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What are major uses for Ceftriazone (ROCEPHIN)?
|
3rd Generation IV Cephalosporin:
Respiratory tract, UTI, Intra-abdominal infection in combo w/ abx w/ anaerobic coverage,MENINGITIS, STDs |
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What are 4th Generation Cephalosporins known to cover?
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Most gram(-) coverage of cephalosporins including PSEUDOMONAS AERUGINOSA and certain Enterobacteraceae that may be resistant to 3rd Generation Cephalosporins
Are broad spectrum-- maintain some gram(+) coverage similar to Cefotaxime and Ceftriaxone |
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What are some of the class adverse side effects seen with Cephalosporins?
|
NMTT rxn w/ Cefamandole & Cefoperazone--Prolonged PT, aPTT &/or hyperprothrombinemia; disulfuram type rxn if combine w/ Etoh
Similar SE profile as PCNs (decreases as generations increase especially w/ Ceftazidime) |
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What affect will be see with food and Cephalosporin administration?
|
Most are unaffected. Oral Cefuroxime (CEFTIN) absorption is enhanced.
|
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What effect can Cephalosporins have when taken w/ oral contraceptives?
|
Potientially decrease effect of contraceptive agent.
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What is the Monobactam?
|
Aztreonam (AZACTAM)
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What is the mechanism of action for Aztreonam?
|
Mono-cyclic beta-lactam derivative-- slightly different structure than Cephs & PCNs
|
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What is the spectrum for Aztreonam?
|
NARROW!! Active only vs GRAM(-) organisms including Pseudomonas
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What is Aztreonam considered and alternative for?
|
AMINOGLYCOSIDES
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What is the major use for Aztreonam (AZACTAM)?
|
Reserved for INPATIENT use (IV ONLY) against resistant gram negative organisms
|
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What are the Adverse effects seen w/ Aztreonam (AZACTAM)?
|
Relatively safe-- may cause local reactions, increased AST, ALT. Low risk of x-allergenicity w/ PCNs.
|
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Which abx is Aztreonam (AZACTAM) most closely related to structurally?
|
CEFTAZIDIME (FORTAZ)
|
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Name the Carbepenems.(3)
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Imipenem/ cilastatin (PRIMAXIM)
Meropenem (MERREM) Ertapenem (INVANZ) |
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What is the mechanism of action for carbepenems?
|
Beta-lactam derivatives similar PCNs and Cepharlosporins
|
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What spectrum of activity do Carbepenems have?
|
VERY BROAD-- most broad spectrum available
Cover gram(+), gram(-) including multi-drug resistant strains & anaerobes |
|
Which carbepenem has better gram(+) coverage against things like Enterococcus?
|
Imipenem/Cilastatin (PRIMAXIN)
|
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Which carbepenem has better gram(-) coverage against things like Pseudomonas?
|
Meropenem (MERREM)
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Which Carbepenem has Pseudomonal and Enterococcal coverage similar to Ampicillin/sulbactam (UNASYN)?
|
Ertapenem (INVANZ)
|
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What function does Cilastatin serve (Imipenem/Cilastatin= PRIMAXIN)
|
Has no antibacterial activity
Is a DIHYDROPEPTIDASE given to decrease the nephrotoxic potential of Imipenem IS NOT a beta-lactamase inhibitor |
|
What are the major uses of Carbepenems?
|
*Often used for tx of polymicrobial infxns
*Are only available IV and are used for SERIOUS infections, suspected or known resistant organisms or critically ill. |
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Is there a need to worry about cross reactivity with Carbepenems and PCN?
|
Is possible
|
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What kind of adjustment is necessary for Carbepenems?
|
Renal adjustment
|
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What are the Adverse effects witnessed w/ Carbepenems?
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1)Nephrotoxicity
2)Seizures 3)GI: N/V/D 4)Rash 5)Drug fever |
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What is the first Quinolone agent?
|
Nalidixic acid-- No longer used
|
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What is the first generation Fluoroquinolone agent & what is it typically used for?
|
Norfloxacin (Noroxin) typically used for UTI
|
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What are the 2nd generation Fluoroquinolone agents?
|
Ofloxacin (FLOXIN) & Ciprofloxacin (CIPRO)
|
|
What are the 3rd generation Fluoroquinolone agents?
|
Levofloxacin (Levaquin)
Trovafloxacin (Trovan) |
|
What are the 4th generation Fluoroquinolone agents?
|
Moxifloxacin (AVELOX)
|
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Which fluoroquinolone has restricted use due to its hepatotoxicity?
|
Trovafloxacin (TROVAN)
|
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What is the mechanism of action for fluoroquinolones?
|
Inhibits Topoisomerase II (DNA gyrase) and Topoisomerase IV; these enzymes are required for DNA replication and transcription--> bacteria cannot replicate
|
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What type of killing do Fluoroquinolones produce-- TIME DEPENDENT or CONCENTRATION DEPENEDENT?
|
CONCENTRATION DEPENDENT bactericidal activity is seen w/ fluoroquinolones
|
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What spectrum of activity is seen w/ Fluoroquinolones?
|
BROAD-- very active against gram(-) bacteria
|
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Which fluoroquinolones have activity against Pseudomonas aerginosa?
|
Ciprofloxacin & Levofloxacin
CIPRO is only ORAL for Pseudomonas!! |
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Strep pneumo and other streptococcal spp are covered by...?
|
Newer fluoroquinolones-- Levofloxacin (LEVAQUIN) Gatifloxacin (removed from market) & Moxifloxacin (AVELOX)
|
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Which fluoroquinolones are considered to be the most "potent" against Strep pneumo?
|
Moxifloxacin (AVELOX) & Gemifloxacin (FACTIVE)
|
|
What are the major uses of Fluoroquinolones?
|
UTI, abdominal infections, respiratory tract infections, skin & skin structure infections (secondary to gram (-) organisms), STD (GONORRHEA) and infections diarrhea
|
|
How are fluoroquinolones most excreted?
|
Renally-- need to adjust w/ renal dysfn
|
|
Which fluoroquinolone doesn't need to be adjusted for renal dysfunction?
|
Moxifloxacin- is excreted in the feces; have to adjust for hepatic dysfunction instead
|
|
What are the adverse side effects seen with Fluoroquinolones?
|
*CNS
*Taste Perversion *GI: N/V *Liver toxicity/ glucose intolerance *Prolonge QT interval *Phototoxicity *Arthritis/Tendonitis |
|
When taking metal-cation containing medications in conjunction with Fluoroquinolones how should they be dosed?
|
2 hours either side of fluoroquinolone dose.
|
|
CYTOCROME P450 RXN:
Ciprofloxacin is a substrate of which CYP?? What will it interact with? |
CYP1A2-- Interacts with Theophylline & Warfarin!!
|
|
Levo-, Gati- & Moxifloxacin should be monitored with which medications and why?
|
Wafarin, Digoxin and Theophylline-- can decrease absorption by as much as 50%
|
|
Which fluoroquinolones can be dosed once a day?
|
Levo-, Gemi & Moxifloxacin
|
|
Cipro-, Moxi- & Levofloxacin are all available as _________ administrations.
|
Both IV & PO
|
|
Which fluoroquinolones need to be monitored with renal dysfunction?
|
ALL except Moxifloxacin (AVELOX)
|
|
What two constituents form BACTRIM or SEPTRA?
|
Sulfamethoxazole and Trimethoprim
|
|
Sulfanilamide is structurally similar to...?
|
PABA-- Para amino benzoic acid-- required for folic acid synthesis in bacteria
|
|
What is the mechanism of action for Trimethoprim?
|
Inhibits dihyrofolate reductase which is an enzyme responsible for bacerial folic acid formation
|
|
What is the mechanism of action for Sulfamethoxazole?
|
Is a PABA analog-- competitively interferes with folic acid synthesis--> prevents bacterial growth
|
|
What spectrum of activity is seen w/ Sulfamethoxazole/Trimethoprim?
|
LIMITED: is Bacteriostatic only
|
|
Bactrim is known to be effective against what organisms? Gram(-), Gram(+), Pseudomonas?
|
Gram(-): including H. influenzae, M. catarrhalis, L. monocytogenes and many Enterobacters
Gram(+): Staph. aureus & Strep pneumo. Effective vs Pneumocystis jiroveci (PCP) & Toxoplasma gondii NO COVERAGE against Pseudomonas or Gp A Strep |
|
What are the major uses for Sulfmethoxazole/ Trimethoprim (BACTRIM)?
|
UTI's, Respiratory tract infections, PCP & against susceptible organisms. MAY be effective vs MRSA (particularly if isolated in urine)
|
|
What are the adverse effects seen with Sulfamethoxazole/Trimethoprim (BACTRIM)?
|
Rash/urticaria, Photosensitivity, GI:N/V, Methemoglobinemia, Crystalluria, Hematologic abnormalities-- including hemolytic anemia in pts w/ G-6PD deficiency, MAY CAUSE FALSE ELEVATION IN SERUM CREATININE
|
|
What drugs might be affected by Bactrim?
|
*Phenytoin, warfarin, methotrexate-- may be displaced
*May INCREASE effect of drugs such as oral hypoglycemic agents |
|
What drug should be avoided as a cocommitant therapy with Bactrim if at all possible?
|
Warfarin-- can increase or decrease INR-- hard to tell what will happen
|
|
What class of antibiotics does Vancomycin fall into?
|
Glycopeptide antibiotics
|
|
What is the mechanism of action of Vancomycin?
|
Bactericidal-- binds to bacterial cell wall and cause blockage of glycoprotein polymerization causing damage to the cytoplasmic membrane of the cell wall.
|
|
What spectrum of activity does vancomycin have?
|
BROAD-- active against aerobic & anaerobic gram POSITIVE organisms
**Including staph, strep pyogenes, strep pneumo., enterococci, corynebacterium and clostridium (including c. diff.) HAS NO ACTIVITY VS GRAM NEGATIVE ORGANISMS |
|
Vanco works vs Gram (+) or Gram (-) bacteria?
|
Gram(+)-- has no activity vs Gram (-) bacteria
|
|
What are the major uses of vancomycin?
|
*Serious gram(+) infections including MRSA (IV) that cannot be treated with other narrow abx
*PCN allergy when beta-lactam drug is primary option or for surgical prophylaxis *Available in capsules which are used in treating C. diff. colitis (Oral form is not absorbed from GI tract--> kills bacteria by direct contact |
|
What is a unique feature of Vancomycin PO when used to treat C. difficile colitis?
|
No bioavailability in serum w/ PO; used because has DIRECT contact in GI to kill C. diff.
|
|
How is vancomycin eliminated?
|
80-90% unchanged in URINE; watch w/ renal dysfunction
|
|
What are the adverse effects seens w/ Vancomycin?
|
*Red-Man's Syndrome (IV) due to rapid rate of administration-- sudden decrease in BP, flushing, rash on face, neck & arms, wheezing, NEPHROTOXICITY, Thrombocytopenia and reversible neutropenia
|
|
What effects are seen with Vancomycin and Aminoglycosides?
|
Enhanced possibility of nephrotoxicity and ototoxicity.
|
|
What effects might been seen when Amphotericin, Cisplatin or Polymixin are given with Vancomycin?
|
Increased nephrotoxicity
|
|
What adverse effects might be seen when furosemide and vancomycin are taken together?
|
Increased risk of ototoxicity
|
|
What side effects might be seen when Vancomycin and neuromuscular blockers are taken together??
|
Enhanced Neuromuscular blockade
|
|
What is the mechanism of action for Linezolid (ZYVOX)?
|
Inhibits bacterial ribosomal protein synthesis by binding to a site on the 23S ribosomal RNA of the 50S subunit
** DIFFERENT BINDING SITE FROM OTHER ABX ** IS BACTERIOSTATIC |
|
What spectrum of coverage does Linesolid (ZYVOX) have?
|
BROAD! Use for multi drug resistant gram(+) cocci
*For Vanco Resistant E. faecium (VRE) *Nosocomial pneumonia caused by MSSA & MRSA |
|
What are the major uses for Linesolid (ZYVOX)??
|
VRE & MRSA, skin & soft tissue infection, diabetic foot & nosocomial pneumonia
|
|
What adverse effects might be seen with Linezolid??
|
N/V/D, REVERSIBLE thrombocytopenia (if tx >2weeks) CBC should be monitored-- VIT B6 may help prevent, rare cases of lactic acidosis, greatly increased LFTs
|
|
What unique cautions should be observed with Linezolid (ZYVOX)??
|
Reversible MAOinhibitor; caution pts about tyramine intake (risk of serotonin syndrom or hypertensive crisis)
** Caution use w/ meperidine, SSRIs, SNRIs & MAOIs |
|
What group of antibiotics does Linezolid (ZYVOX) belong to??
|
Oxazolidinone
|
|
What type of antibiotic does Cubicin (DAPTOMYCIN) belong to?
|
Is a lipopeptide antibiotic
|
|
What is the mechanism of action for Cubicin (Daptomycin)?
|
Binds to bacterial membrane & causes rapid depolarization of membrane potential
*Results in inhibition of protein, DNA & RNA synthesis--> cell death |
|
Cubicin is CONCENTRATION or TIME dependent killing?
|
Concentration dependent-- Bactericidal
|
|
What spectrum does Cubicin (DAPTOMYCIN) have?
|
BROAD-- Used for multidrug reistant aerobic gram (+) cocci and for Vancomycin Resistant E. faecium (VRE)
|
|
What are the major uses for Cubicin (DAPTOMYCIN)?
|
Severe infections when vancomycin or linesolid is not an option or if bactericidal activity desired
|
|
What are the adverse effects seen with Cubicin (Daptomycin)?
|
MAJOR side effects= myalgia and increased creatine phosphokinase (CPK)-- monitor; if >5x's norm d.c daptomycin
|
|
What type of antibiotic is CUBICIN?
|
Lipopeptide antibiotic
|
|
What type of antibiotic is Synercid?
|
Streptogramin antibiotic
|
|
What is the mechanism of action for Synercid (DALFOPRISTIN/QUINOPRISTIN)?
|
*Inhibits bacterial growth by binding to different sites on the 50S subunit of the ribosome
*Interferes w/ bacterial protein (ribosomal) synthesis |
|
What is the spectrum of activity for Synercid (dalfoprisitn/quinopristin)?
|
BROAD-- Gram(+) cocci such as Staph spp including MRSA (bactericidal) & VRE (Enterococcus faesium only) (bacteriostatic)
|
|
What are the major uses of Synercid??
|
*Severe life-threatening infections VRE when other agents fail or are contraindicated
*Complicated skin & skin structure infections *Used infrequently due to adverse effects |
|
What are the unique precautions/ adverse effect seen with Synercid?
|
Infusion related (thrombophlebitis, inflammation, edema)
MUST BE ADMINISTERED VIA CENTRAL LINE d/c w/ arthralgias and myalgias |
|
What is the mechanism of action of Rifampin (RIFADIN)?
|
Blocks bacterial RNA transcription by binding to DNA dependent RNA polymerase.
|
|
What is the spectrum of activity for Rifampin (RIFADIN)?
|
NARROW: Active against Mycobacterium tuberculosis, N. meningitidis, Staph aureus
|
|
What are the major uses for Rifampin (RIFADIN)?
|
*Post exposure prophylaxis against N. meningitidis and H. influenzae type B
*Very effective vs. MRSA HOWEVER when used alone resistance develops rapidly *MUST be used as adjunctive tx w/ Vanco or Minocyclin or Bactrim |
|
When using Rifampin in treating MRSA, what adverse effects might be seen?
|
Most common= Rash, N/V
*Muscular & joint pain including cramping *Increase LFTs *Reddish-orange discoloration of urine, feces, sweat, tears-- may even discolor contact lenses |
|
What drug interactions might be seen with Rifampin?
|
May possibly decrease medication effects-- Diltiazem, digoxin, amiodarone, diazepam, haloperidol, metoprolol, morphine, prednisone, rofecoxib, warfarin.. etc.
** INDUCES CYP450** |
|
What is the mechanism of action of Metronidazole (FLAGYL)?
|
Is reduced to toxic metabolites when it enters cells--> damages bacterial DNA and results in cell death
|
|
What spectrum of activity does Metronidazole (FLAGYL) have?
|
NARROW: active vs anaerobic bacteria including Baceroides fragilis and C. dificile, protozoa (Trichomonas, Giardia) H. pylori
|
|
What are the major uses of Metronidazole (FLAGYL)?
|
**DRUG OF CHOICE for treating C. difficile, bacterial vaginosis
*Used topically to treat acne *Useful in polymicrobial infxns (combined w/ other agents) *Treatment of peptic ulcer dz (H. pylori) |
|
What unique effects or cautions might be seen with Metronidazole (FLAGYL)?
|
GI effects are most common, peripheral neuropathy, disulfram-type rxn & avoid in pregnancy or lactation
|
|
What drug interactions might be seen with Metronidazole (FLAGYL)?
|
**Phenobarbitol, phenytoin,carbamazepine, rifampin-- may increase metabolism of metronidazole
**Anticoagulant effect of warfarin might be increased |
|
Name the Gycylcycline antibiotic.
|
Tigecycline (TYGACIL)
|
|
What is the mechanism of action for Tigecycline??
|
Similar to tetracycline derivatives-- binds to 30S subunit of ribosome
*structurally similar to minocycline |
|
What is the spectrum of activity for Tigecycline (TYGACIL)??
|
VERY BROAD SPECTRUM-- activity vs GRAM(+)-- including MRSA and VRE and GRAM(-) except Pseudomonas and anaerobic bacteria
|
|
What type of activity does Tigecycline (TYGACIL) have? Bacteriostatic or Bactericidal?
|
Bacteriostatic
|
|
What are the major uses of Tigecycline (TYGACIL)?
|
FDA approved for complicated intra-abdominal & complicated skin and skin structure infxns
Reserved for SEVERE infxns in hospital setting-- IV ONLY |
|
What are the adverse effects seen with Tigecycline?
|
Major S.E. is N/V
|
|
Why is the use of polymixins limited?
|
Use is limited due to risk of Neurotoxicity Nephrotoxicity-- dose dependent
|
|
Polymixins are active against....?
|
Pseudomonas and Acinetobacter and other GRAM(-) organisms
|
|
What is the mechanism of action for Chloramphenicol??
|
Inhibits protein synthesis by reversible binding to 50S subunit of 70S ribosome
|
|
The activity of Chloramphenicol is Bactericidal or Bacteriostatic??
|
BACTERICIDAL
|
|
What spectrum of activity does Chloramphenicol have?
|
BROAD-- 1st Broad spectrum abx discovered.
*Spectrum similar to Tetracycline (Gram(+), Gram(-) and anaerobic coverage *Does not cover Staph spp but has been used w/ VRE w/ some success. |
|
What are the major uses of Chloramphenicol?
|
Typhoid fever, Haemophilus meningitis & lots of unique infxn
|
|
What are the 3 major toxicities seen with Chloramphenicol?
|
1)Aplastic anemia-- usually 3 weeks to 12 mos
2)Bone marrow suppression after short term and prolonged tx (may be dose related) 3)Grey baby syndrome-- characterized by circulatory collapse, cyanosis, acidosis, abdominal distention, myocardial depression, coma, death- associated w/ babies w/ severe liver dz who cannot conjugate the drug at high levels |
|
How is Chloramphenicol metabolized?
|
Conjugated by the liver w/ glucuronic acid-- forms monoglucuronoide (WATER SOLUBLE)
Is then excreted in bile in sm intestine--> hydrolyzed by bacteria to aglycone, reabsorbed and conjugated again **Results in 80-90% of monoglucuronide is excreted by kidney. |
|
What is the mechanism of action for Nitrofurantoin (MACRODANTIN)??
|
Poorly understood-- appears to require enzymatic reduction w/in the bacteria and then inhibits bacterial translation
|
|
What is the spectrum of activity for Nitrofurantoin (MACRODANTIN)??
|
NARROW-- Typically susceptible include E.coli, Staph, Strep, Enterococcus including VRE & Citrobacter
|
|
What are the major uses of Nitrofurantoin (MACRODANTIN)?
|
EXCLUSIVELY for UTI tx or prophylaxis
|
|
What are the unique precautions/ adverse effects seen w/ Nitrofurantoin (MACRODANTIN)?
|
*Hemolytic anemia has occured in pts w/ G6PD deficiency
*Avoid w/ CrCl<60ml/min *DOES NOT reach site of infxn *May accumulate & cause adverse effects (Ascending polyneuropathy |
|
Antibiotics don't treat diseases...
|
They kill the bugs that CAUSE diseases.
|
|
What are some examples of Gram(+) organisms??
|
*Staphylococcus spp
*Streptococcus spp *Enterococcus *Clostridium |
|
What are some examples of Gram(-) organisms?
|
*Enterobacteraciae-- E.coli, Proteus, Enterobacter, Pseudomonas
*Neisseria spp * Helicobactor pylori |
|
What are the Tetracycline antibiotics? (4)
|
1)Demeclocycline--Declomycin
2)Doxycycline-- Vibramycin, Vibra-tabs ets 3)Minocycline-- Dynacin, Minocin, Myrac, Solodyn 4)Tetracycline |
|
What is the mechanism of action for Tetracyclines?
|
Inhibit protein synthesis by reversibly binding to 30S ribosomal subunit and inhibit binding to tRNA
|
|
What are some of the major uses for Tetracyclines?
|
Anthrax,Lyme dz, Chlamydia, Mycoplasma & Rickettsia infxn
**Demeclocycline is used to tx SIADH (primarily) |
|
What is the spectrum of activity of Tetracyclines?
|
Broad/Limited
|
|
Are Tetracyclines Bacteriostatic or Bacteriocidal?
|
BACTERIOSTATIC; b/c of resistance they are not used against common gram (+) & (-) bacteria-- use is very limited
|
|
What are some unique cautions w/ tetracyclines?
|
Don't use in children >8y/o
Don't use in pregnancy Photosensitivity Hepatotoxicity Superinfxn possible GI: N/V/D or anorexia Jarisch- Herxheimer rxn when treating brucellosis or spirochetal infxn OUTDATED drug can cause nephrotoxicity |
|
What interactions can be seen between Tetracyclines and Ca, Mg, Al, Zn, Bismuth, Dairy, Bile acid sequestriants Kaolin or pectin??
|
Can cause decrease absorption of tetracyclines
|
|
What should be done to keep Tetracyclines from reacting w/ Ca, Mg, Al, Zn, Fe or dairy products?
|
Separate dosing by 1-2 hrs before or after
|
|
What effects can tetracycline have on Warfarin or Digoxin?
|
Can increase effects of Warfarin or Digoxin
|
|
Doxycycline and Tetracycline are major substrate of...?
|
CYP3A4; Decreased doxycycline levels w/ Rifampin, Phenobarbital, Carbamazepine and others
MAY INCREASE levels of other CYP 3A4 substrates |
|
How should Tetracylines be taken?
|
ON empty stomach (except doxycycline-- can be taken w/o regard)
|
|
What cautions in dosing should be observed?
|
Caution in Hepatic and renal dosing-- Reduce or avoid
EXCEPT doxycycline-- no adjustment necessary |
|
Name the Macrolide antibiotics
|
1)Azithromycin--Zithromax, Zmax
2)Clrithromycin--Biaxin, Biaxin XL 3)Dirithromycin--Dynobac 4)Erythromyin--Erytab, Eryderm, EryPed, Erythrocin 5)Troleandomycin |
|
What is the mechanism of action for Macrolides?
|
Inhibits protein synthesis by binding reversibly to 50S ribosomal subunit, blocks peptide elongation
|
|
What are the major uses of Macrolide antibiotics?
|
*Upper & Lower respiratory tract infxns
*Atypical bacterial infxns *H. pylori, Mycobacterium avium complex (MAC) Mycobacterium avium intracellular (MAI) *ACNE |
|
What is the spectrum of activity for Macrolide ABX?
|
NARROW/BROAD--
Bacteriostatic OR Bacteriocidal at higher concentrations **Broad aerobic gram (+) & actinomycetes, mycobacteria, legionella, mycoplasmas, chlamydia, rickettsiae, treponemes **IS DRUG OF CHOICE for ATYPICALS** |
|
What are some unique cautions w/ Macrolides??
|
1)Prolonged QT intervals-- concurrent use w/ cisapride, pimozide or ergot derivatives
2)Risk of Superinfection 3)GI: N/V/D/Gas 4)Cholestatic hepatitis-- esp w/ erythromycin 5)Transient hearing loss-- associated w/ lg IV doses of Erythromycin |
|
Macrolides are known to _______ CYP3A4 and CYP1A2
|
INHIBITS
|
|
Macrolides may _________ levels of digoxin, warfarin, pimozide, cisapride, carbamazepine, phenytoin, VPA, Benzos, ergot derivatives, quinidines rifampin & others...
|
INCREASES levels-- inhibits CYP3A4 & CYP1A2-- therefore increases levels of medications that are substrates
|
|
Which macrolides need to be adjusted for Renal dysfunction?
|
Azihromycin & Clarithromycin
(Don't change w/ Dirithromycin or Erythromycin) |
|
Which macrolides need to be adjusted for hepatic dysfunction?
|
Azithromycin, Dirithromycin, Erythromycin-- use caution -- no specific guidelines available
Don't need to adjust Clrithromycin if renal fn is normal |
|
What is the Ketolide antibiotic discussed?
|
Telithromycin (KETEK)
|
|
What is the mechanism of action of Telithromycin (KETEK)?
|
Blocks protein synthesis by binding to 23S ribosomal RNA of the 50S ribosomal subunit
|
|
What are the major uses for Telithromycin (KETEK)??
|
*Community acquired pneumonia
*Other indications removed by the FDA & manufacturer due to liver toxicity |
|
What is the spectrum of activity of Telithromycin (KETEK)?
|
NARROW-- Bacteriostatic or Bacteriocidal at higher concentrations
|
|
What bugs are Telithromycin (KETEK)?
|
Aerobic gram (+) resistant Strep pneumoniae & atypicals
|
|
What unique cautions should be considered with Telithromycin (KETEK)?
|
*Acute Hepatic failure
*Prolongation of QT intervals *Exacerbation of myasthenia gravis |
|
What are the common side effects seen w/ Telithromycin (KETEK)?
|
Diarrhea/ loose stools, N/V, HA, dizziness, dysgeusia
|
|
What effects would Telithromycin have w/ CYP3A4?
|
Ketek is metabolized and inhibits CYP3A4.
|
|
CYP3A4 inducers may cause _____ levels of Telethromycin
|
SUB-THERAPEUTIC; drugs like Rifampin, Phenytoin, Carbamazepine, Phenobarbital
|
|
CYP3A4 inhibitors may ______ levels of Telethromycin
|
INCREASE; drugs like Itraconazole, Ketoconazole, Ciprofloxacin & Macrolides
|
|
Telithromycine may ______ levels of B-blockers, Digoxin, & Warfarin
|
may INCREASE levels of B-blockers, Digoxin & Warfarin
|
|
Renal dosing of Telithromycin calls for...?
|
adjustment when CrCl <30ml/min calls for reduxn to 600mg PO-- including pt on hemodialysis-- give does afer dialysis session
|
|
Hepatic dosin of Telithromycin...
|
Hepatic impairment w/ CrCl <30ml/min calls for dose reduxn to 400mg PO daily
|
|
What are the Lincosamide antibiotics?
|
Clindamycin-- CLeocin HCl, Clindagel, CLindaMAx
Lincomycin-- Lincocyin |
|
What is the mechanism of action for Lincosamides?
|
Inhibits protein synthesis by binding reversibly to the 50S ribosomal subunit blocking protein eleongation
|
|
The D-test is used to test for....?
|
Inducible Clindamycin resistance
|
|
What are the major uses for Lincosamide abx?
|
Infxns involving susceptible organisms, Pelvic inflammatory dz & severe acne
|
|
What is the spectrum of activity for Lincosamide abx?
|
NARROW-- Bacteriostatic or bacteriocidal at higher concentrations
** Effective vs Staph & Strep, anaerobes such as baceroides, peptococcus, peptostreptococcus, protozoa |
|
What are some unique cautions to be considered when using Lincosamide antibiotics?
|
1)Previous psedomembranous colitis; regional enteritis, ulcerative colitis
2)Hypersensitivity rxns 3)Cautions inpts w/ renal or hepatic dysfn 4)Rash, urticareia, increased LFTs azotemia, proteinuria, neutropenia, leukopenia |
|
What drug interactions might be seen with Lincosamides?
|
May enhance the neuromuscular blocking effect of neuromuscular-blocking agents
|
|
What considerations should be made in consideration with Lincosamides and food, renal or hepatic impairment?
|
Food: Clindamycin can be taken w/o regard to food
Renal impairment-- reduce dose of Lincomycin Hepatic impairment-- dose adjustment recommended for both Clindamycin & Lincomycin |
|
Amikacin, Gentamicin, Kenamycin, Neomycin, Streptomycin and Tobramycin are all examples of________ abx.
|
AMINOGLYCOSIDE antibiotics
|
|
Amikacin--AMICIN
Gentamicin--GENTAK Kanamycin--KENTRAX Neomycin--NEO-FRADIN, NEO-RX Streptomycin Tobramycin-- AKTOB, TOBI, TOBREX |
AMINOGLYCOSIDE ANTIBIOTICS
|
|
What is the mechanism of axn of aminoglycosides??
|
Inhibits protein synthesis by irreversibly binding the 30S ribosomal subunit at MULTIPLE binding sites
**EXHIBITS POST ANTIBIOTIC EFFECT** |
|
Wat is a unique feature of aminoglycosides?
|
Exhibit post-antibiotic effects
|
|
What are the major use for Amikacin, Gentamicin & Tobramicin?
|
Hospital acquired pneumonia, Ventilator acquired pneumonia, meningitis, intra-abdominal infxn
*synergistic effect w/ B-lactam or vancomycin for pseudomonas infxns* |
|
What are the major uses for Streptomycin?
|
Tx of TB, Mycobacterium avium complex--> AIDS; opportunistic
|
|
What are the major uses for Neomycin?
|
Topical use for minor skin infxns, oral for preoperative abdominal antisepsis
|
|
What is the major indication for Kanamycin??
|
HAS LIMITED COVERAGE-- intraabdominal infections
|
|
What is the spectrum of activity for Aminoglycosides??
|
NARROW-- Concentration dependent bactericidal activity
|
|
Aminoglycosides have TIME-DEPENDENT or CONCENTRATION- DEPENDENT killing?
|
CONCENTRATION-DEPENDENT killing
|
|
Aminoglycoside antibiotics are effective against primarily_________?
|
AEROBIC GRAM(-) BACILLI
|
|
Which Aminoglycoside has the greatest activity vs mycobacterium?
|
Streptomycin
|
|
Which aminoglycoside has the most activity vs Pseudomonas aeruginosa??
|
Tobramycin
|
|
What are some unique cautions with Aminoglycoside antibiotics?
|
**DO NOT USE IN PREGNANCY
**Nephrotoxicity-- usually reversible **Ototoxicity-- IRREVERSIBLE; damage to vestibular or cochlear structures or both; increases w/ cumulative doses *Neomycin should not be used w/ intestinal obstruxn |
|
Aminoglycoside antibiotics are known to increase nephrotoxicity when taken cocomittantly with....?
|
PCN, Cephalosporins, Amphotericin B, Loop Diuretics or Vancomycin
|
|
Increased risk of aminoglycoside potentiated ototoxicity is seen with...?
|
VANCOMYCIN and LOOP DIURETICS
|
|
It is important to separate dosing of Aminoglycoside and B-lactam abx because...?
|
Beta-lactams can deactivae Aminoglycosides-- should separate doses
|
|
Gentamycin and Tobramycin should be dosed by _______ body weight.
|
IDEAL BODY WEIGHT
|
|
Peaks for Aminoglycosides should fall between ____ & ___ mcg/ml and troughs should be ______mcg/ml
|
Peaks 3-10 mcg/ml
Troughs <2 mcg/ml |
|
Amikacin should be dosed by ____ body weight.
|
Ideal body weight.
5-7.5 mg/kg/dose q 8hrs IV, IM MONITOR |
|
The typical dosing from Streptomycin is...?
|
15-30mg/kg/day (IM)MONITOR
|
|
Which aminoglycoside can be dosed without regard for renal function?
|
NEOMYCIN
|
|
Which aminoglycosides need to be dosed with regard for hepatic deficiency?
|
Gentamicin & Tobramycin-- monitor levels
|
|
The typical dosing for Neomycin is...?
The typical dosing for Kanamycin is...? |
Neomycin- 90mg/kg/day in divided doses q4hrs PO
Kanamycin-- DOSE BY IBW; 5-7.5 mg/kg/day in 2-3 divided doses IV or IM--MONITOR |
|
Which aminoglycoside doesn't have an injectible form?
|
NEOMYCIN-- Tablet and oral solution available
|
|
Which aminoglycosides have opthalmic preparations?
|
Gentamicin & Tobramycin
|
|
What are the 4 key points to remember with Aminoglycosides in general?
|
1)Work against Gram(-) bacilli
2)Synergy 3)Oto & Nephrotoxicity 4)Monitor |
|
Define Community Acquired Pneumonia
|
Lower respiratory tract invection in a patient living w/in the community or outpt setting
*Also applicable to ambulatory nursing home |
|
With a suspected case of CAP what would some of the subjective presentations be?
|
Deep cough, Increased or changed sputum production, SOB, Chills, Night sweats, Fatigue, Malaise, Weakness, Chest pain (pleuritic)
|
|
With a suspeted case of CAP waht would some of the objective presentations be?
|
Fever (>38C), Increased RR, Sputum production, TACHYCARDIA, ELEVATED WBC, BANDEMIA (Left Shift), Decreased breath sounds, Decreased O2 saturation, Infiltrate on Chest X-ray
|
|
What are the clinical presentations that are associated with an increased risk of death?
|
RR>/=30/min, Diastolic BP </= 60mmHg (Hypotension), Confusion, A Fib, Multilobar Involvement, Hypoxemia, Leukopenia, Bacteremia
|
|
What are some of the risk factors associated with CAP?
|
Oropharyngeal colonization, Risk of aspiration, Elderly, Recent ABX use, Immune status, Underlying/preexisting lung dz
|
|
What are the five MOST common pathogens in CAP?
|
1)Strep pneumoniae
2)Respiratory viruses 3)M. pneumoniae 4)C. pneumoniae 5)H. Influenzae |
|
What are the five LESS common pathogens in CAP?
|
1)Legionella
2)Pseudomonas 3)Enteric Gm Negatives (Gut- aspirated 4)Staph aureus (??CA-MRSA??) 5)Anaerobes |
|
In dx RTI, modifying factors prove to predispose pts to attack from certain bugs--
1)COPD/Smokers 2)Alcoholism 3)Nursing Home 4)Aspiration |
1)H. influenzae, Strep. pneumo., Pseudomonas
2)Strep. pneumo., oral anaerobes, gram negatives (Klebsiella pneumonia) 3)Strep. pneumo, G(-) bacilli, H. influenzae, Staph. aureus, anaerobes 4) G(-) enteric pathogens, oral anaerobes |
|
HIV/Aids patients might be predisposed to RTI caused by...?(8)
|
1-Strep. pneumo
2-H. influenzae 3-M. tuberculosis (late in dz) 4.PCP 5. Cryptococcus 6. Histoplasma 7. Aspergillus 8. atypical Mycobacteria |
|
Which three antibiotics provide EXCELLENT atypical coverage in treatment of CAP?
|
Fluoroquinolones, Macrolides & Doxycycline
|
|
Which two pathogens have the HIGHEST mortality rate in CAP?
|
Pseudomonas aeuginosa & Klebsiella Pneumoniae
|
|
Which pathogens has the lowest rate of mortality in CAP?
|
Moraxella pneumoniae
|
|
PORT & CURB criteria are used to assess?
|
CAP treatment-- In or Out patient & Mortality risk
|
|
A good sputum sample has _____ Polymorphonuclear Leukocytes & _______ Epithelial Cells
|
>25 PMNL's & < 25 Epithelial cells-- Low #'s WBC= may be colonization NOT infection; High #'s of epithelial cells = spit NOT sputum
|
|
What test is used to detect Legionella in Patients with CAP?
|
Legionella Urinary Antigen
Detets Legionella pneumophilia w/ ~70-90% accuracy w/ a specificity of 99% |
|
Which test is used to detect Influenza in patients with CAP?
|
Influenza Rapid Antigen Test; tests for Influenza A & B w/ results in 15-30 mins. Has a sensitivity of 50-70% and 100% specificity
|
|
What are the goals of therapy for CAP?
|
1)Treat infection & irradicate bacteria
2)Prevent complications 3) Maintain normal activity |
|
When treating CAP in OUTPATIENT setting w/ no RECENT ABX tx therapy might include Macrolides or Doxycycline-- WHY??
|
Macrolides-- Azithro-, Erythro- or Clarithromycin cover atypical pathogens eg/ Mycoplasma spp, Chlamydia spp & Legionella spp
Doxycycline covers atypical pathogens but is NOT approved in kids <8y/o |
|
In treating CAP in an OUTPATIENT setting for a person w/ recent ABX tx OR comorbidities such as COPD, Immunosuppressed, DM, CRF, CHF, Asplenia or CA what might be used and why?
|
Azithro or Clarithromycin + high dose AMOX OR high dose AMOX + 2nd or 3rd generation Cephalosporin b/c Amox will treat most strains of S. pneumoniae
OR Respiratory fluroquinolones-- Levo-, Moxi- or Gemifloxacin b/c covers atypicals (NOT for kids) |
|
Empiric treatment of patients for CAP w/ suspected aspirations Augmentin or Clindamycin is often suggested-- why?
|
COVERS ANAEROBIC BACTERIA!
|
|
When empirically treating outpt with CAP caused by influenza w/ bacterial superinfection what antibiotics might be suggested?
|
Beta-lactam (Hi dose Augmentin, Cefpodoxime, cefprozil, cefuroxime)or Respiratory Fluoroquinolones (Levo-,Moxi or Gemifloxacin)
|
|
When treating CAP on a general ward floor IDSA/ATS 2007 guidelines suggest which antibiotics?
|
1)Ceftriaxone plus a macrolide
OR 2)Respiratory Fluoroquinolones (Levo-, Moxi or Gemifloxacin) |
|
When treating CAP in an ICU ward pt what recommendations would the IDSA/ATS 2007 guidelines have?
|
1)Ceftriaxone + Azithromycin or a fluoroquinolone or for PCN allergy a Resp fluoroquinolone + Aztreonam
|
|
When empirically treating CAP why would Macrolides be used? Advantages/ Disadvantages?
|
Advantages: Works vs most common pathogens including atypicals; Azith & Clarithromicin can be given w/ ODD & better tolerated than Erythromycin
Disadvantages: Strep. pneumo resistance being reported. Erythromycin DOES NOT have activity vs. H. influenzae |
|
When empirically treating CAP why would AMOXICILIN be used? Advantages/ Disadvantages?
|
Advantages: PREFERRED drug for Strep. pneumo- active vs 90-95% of straing at 3-4g/day
Disadvantages: Lacks activity vs atypical and B-lactamase producing bacteria |
|
When empirically treating CAP why would AUGMENTIN be used? Advantages/ Disadvantages?
|
Additional coverage vs H. influenzae, M. cattarhallis, Staph aureus & anaerobes (vs AMOX)
Disadvantages:Lacks atypical coverage, more GI problems & $$ |
|
When empirically treating CAP why would ORAL CEPHALOSPORINS be used? Advantages/ Disadvantages?
|
Advantages:Active vs Strep. pneumo and virtually all H. influenza
Disadvantages: Inactive vs Atypicals: amox more effective vs Strep. pneumo. |
|
When empirically treating CAP why would Doxycycline be used? Advantages/ Disadvantages?
|
Advantages: Active vs 90-95% or Strep pneumo. & H. influenzae
Disadvantages: Limited data w/ severe ill |
|
When empirically treating CAP why would Resp Fluoroquinolones--Levo-, Moxi- or Gemifloxacin) be used? Advantages/ Disadvantages?
|
Advantage: Active vs >98% of Strep pneumo and all other common org. & ODD
Disadvantages:Expensive risk of abuse |
|
When empirically treating CAP why would Telithromycin be used? Advantages/ Disadvantages?
|
Advantages: Has activity vs. Strep. pneumo. resistant to PCN & macrolides
Disadvantages: Drug-drug interaction, hepatotoxicity, QT prolongation |
|
With empirical treatment of CAP why would Clindamycin be used? Advantages/ Disadvantages?
|
Advantages: Active vs 90% of Strep. pneumo., Staph. aureus & ANAEROBES
Disadvantages: Lacks atypical coverage, High rate of diarrhea & C. diff. colitis |
|
When treating CAP in a hospitalized patient, what courses of antibiotics might be used?
|
A: Ceftriaxone (ROCEPHIN 1g/QD)or Cefotaxime (CLAFORAN 1g IV TID) PLUS Azithromycin (ZITHROMAX 500mg IV/PO QD) or Clarithromycin or Doxycycline
B: Moxifloxacin (AVELOX-400mg IV/PO QD)or Levofloxacin (LEVAQUIN 750 IV/PO QDx5) |
|
What antiviral medications may be initiated if CAP develops secondary to influenza?
|
Oseltamivir (TAMIFLU)
*Inhibits neuraminidase enzyme and pevents release of new virions from host cell; active vs both Flu A & B ** MUST INITIATE w/in 48hrs!!** |
|
What are the 3 major syndromes associated with pneumonia caused by aspiration?
|
1)Chemical pneumonitis-- abrupt increase in wbc; acid
2) Bronchial obstruction secondary to aspiration of particulate matter 3) Bacterial aspiration pneumonia |
|
What predisposing conditions are connected to aspiration pneumonia?
|
*Alterations in Consciousness
Alcoholism, Seizure disorders, general anesthesia, CVA, Drug intoxication, head injury, severe illness w/ obtundation (Lose ability to swallow) *Imparied swallowing *NG tube *Trach/ Endotrach tube *Periodontal dz |
|
What medications are prescribed for tx of aspiration pneumonia in an OUTPATIENT setting?
|
1- Clindamycin
2- Augmenting 3- Fluoroquinolones or 2nd/3rd Gen Cephalosporins + Clindamycin or Metronidazole |
|
What medications are prescribed for tx of aspiration pneumonia in an inpatient setting?
|
1- Ampicillin/ sulbactam (UNASYN)
2) Pipercillin/tazobactam (Zosyn) 3) 3rd/ 4th Gen Ceph IV + Clindamycin IV or Metronidazole IV 4)Fluoroquinolones IV +Clindamycin IV or Metronidazole IV |
|
What criteria are necessary to convert CAP pts from IV to PO antibiotics?
|
** Hemodynamically stable
** Temp <100 for at LEAST 8 hrs (most use 24h) ** Improving clinically |
|
Unasyn or Zosyn IV treatment therapies are switched to which abx?
|
Augmentin for Unasyn
Augmenting + CIPRO for Zosyn |
|
What CAP antibiotic regimens are only available PO?
|
Clarithromycin (BIAXIN), Erythromycin (E-mycin), Telithromycin (KETECK)& Gemifloxacin (FACTIVE)
|
|
How many days should afebrile CAP pts be treated?
How many days will most patients w/ CAP be treated? |
MINIMUM of 5 days
Most 7-10 days |
|
Newer guidelines suggest when treating Strep. pneumo. abx therapy may be d/c'ed when?
|
Once pt is afebrile for 72hrs.
|
|
When treating CAP caused by Legionella how long with the course of treatment last?
|
14 days.
|
|
Define Hospital acquired Pneumonia.
|
Pneumonia that occurs 48hrs or more after admission which was not incubating at time of admission.
|
|
Define Ventilator acquired pneumonia
|
Arises 48-72hrs after endotracheal intubation
|
|
What does HCAP stand for?
|
Healthcare- associated Pneumonia
|
|
What are the criteria for HCAP
|
*Hospitalized in acute care for 2 or more days/90days
*received IV abx, chemo or wound care w/in 30days of current infxn *attended hospital or hemodialysis clinic |
|
In ventilated patients the incidence of risk ______ with the duration of ventilation.
|
INCREASES
|
|
What are some sources of pathogens in VAP/HAP
|
Healthcare devices, Environment, Staff
|
|
What are some non-modifiable risk factors for HAP?
|
Sex- more likely in males
Underlying dz-state- eg/ COPD |
|
What are some modifiable risk factors for HAP?
|
Intubation/mechanical ventilation, Body positioning, Enteral feedings, concomitant medication use, Transfusion, HYPERGLYCEMIA
|
|
Early HAP/VAP vs Late HAP/VAP
|
Early= w/in 4 days
Late= w/in more than 5 days |
|
What is the mortality rate for HAP/VAP?
|
30-70% in studies; many die of underlying disease states; Bacteremia associated w/ INCREASED mortatlity risk
|
|
What are the stereotypical GRAM NEGATIVE microorganisms associated w/ HAP/VAP?? (5)HINT SPACE
|
SPACE
1)Serratia spp 2)Pseudomonas spp 3)Acinetobacter spp 4)Citrobacter spp 5)Enterobacter spp |
|
What GRAM POSITIVE microorganisms associated w/ HAP/VAP?
|
Staphylococcus aureus, Streptococcus pneumoniae, Oropharyngeal pathogens-- strep viridans, coagulase negative Staph., Corynebacterium
|
|
What aypical microorganisms my be associated w/ HAP/VAP?
|
Legionella, Viruses, Fungus
|
|
What are the typical causative agents for EARLY ONSET nosocomial pneumonia?
|
Strep. pneumo., H. influenzae, Staph. aureus, VIRUSES
|
|
What are the typical causative agents for LATE ONSET nosocomial pneumonia?
|
Pseudomonas aeruginosa, Staph aureus (Both MSSA & MRSA), aerobic GRAM(-) bacilli eg/ ACINETOBACTER spp, Enterobacteriacae spp such as Klebsiella pneumoniae
|
|
What are the risk factors for multidrug resistant pathogens associated w/ HAP/VAP?
|
*Antimicrobial tx w/in 90 days
*Current hospitalization *ABX-resistance w/in community *Presence of risk factor for HCAP *Immunosuppressive dz &/or tx |
|
Diagnosis of HAP/VAP must include:
|
*Radiographic infiltrate
*Clinical findings of infxn (Onset of fever, purulent sputum, Leukocytosis, decline in O2) |
|
If clinical findings of infections are present but chest x-ray reveals NO infiltrate the diagnosis is_____?
|
Tracheobronchitis
|
|
Diagnostic strategies for HAP typically include presence of infiltrate on CXR +....?
|
at least ONE of the following:
FEVER (at least 38C), LEUKOCYTOSIS, PURULENT TRACHEAL SECRETNS |
|
A bronchoscopy will...?
|
Scope into R or L or BOTH lungs can allow visual or to take culture
|
|
What factors should be considered when selecting abx tx in the treatment of HAP?
|
*Previous ABX tx
*Pt disposition *Known prevalence of resistance patterns *Duration of hospitalization *Patient condition |
|
Initial selection of abx for treatment of HAP might include________?
|
Piperacillin/Tazobactam (Zosyn) OR Ceftriazone (ROCEPHIN) + Clindamycin (CLEOCIN)
If PCN Intollerant: Cipro- or Levofloxacin + Clindamycin |
|
If MRSA is suspected in HAP/VAP or HCAP-- what drug might be added on to or in place of Clindamycin (CLEOCIN)?
|
VANCOMYCIN
|
|
What abx might be added in HAP/VAP/HCAP regimin if atypical pathogens are suspected?
|
Azithromycin or Levofloxacin (IV or PO)
|
|
When EMPIRICALLY treating HAP what are the ABX choices?
|
*Antipseudomonal Cephalosporins: Cefepime & Ceftazidime
*Antipseudomonal carbapenem: Imipenem or Meropenem *B-Lactamase/B-lactamase inhibitor +Antipseudomonal fluoroquinolone: ZOSYN + Cipro or Levofloxacin *Aminoglycosides: Tobra-, Gentamycin, Amikacin |
|
When EMPIRICALLY treating HAP with suspected MRSA what abx are chosen?
|
VANCOMYCIN or LINESOLID (ZYVOX)
|
|
When EMPIRICALLY treating HAP w/ Legionella pneumophilia what should be added to the treatment regimine?
|
Fluoroaquinolones or Azithromycin instead of aminoglycosides
|
|
What type of killing is seen in therapeutic vancomycin dosing? Time-dependent or concentration- dependent??
|
TIME DEPENDENT
|
|
What are the reasons for deterioration or non-resolution of pneumonia in response to abx therapy?
|
*NOT pneumonia; wrong dx
*Etiology-- not bacterial; could be yeast or viral *Complicated pneumonia; abscess *RESISTANT pathogen *Breakthrough infxn (Dose too low) |
|
Narrowing of antibiotics to the targeted pathogen is important to prevent...?
|
COLLATERAL DAMAGE
|
|
Which microorganism is the biggest problem with collateral damage?
|
C. diff.
|
|
What should pseudomonas be double covered with?
|
Aminoglycosides or Ciprofloxacin typically-- can stop double coverage when patient starts to get better.
|
|
Why are children so susceptible to Acute Otitis Media?
|
Decreased cellular and humoral immunity
|
|
What organisms are resposible for nearly 70% or bacterial otitis media cases?
|
Strep pneumo., H. influenzae, M. catarrhalis
Gram(+): Staph. aureus, GAS Gram(-): E.coli Atypicals: Chlamydia & Mycoplasma |
|
Define Middle Ear Effusion
|
Any fluid in the middle ear space regardless of cause
|
|
Define Myringitis
|
Erythema of tympanic membrane w/out middle ear effusion; can be mimicked by crying
|
|
Define Otalgia
|
Ear Pain
|
|
Define Otorrhea
|
Discharge from the ear
|
|
Define Myringotomy
|
Slit made in the ear drum to allow drainage of fluid
|
|
Define Tympanocentesis
|
Small gauge needle inserted to drain fluid from middle ear
|
|
Acute Otitis Media s/sx's include:
|
Sudden onset of pain, irritability, fever, nasal congestion, coughing, loss of appetite, vomiting, ear drainage, recent URI
|
|
On otoscopic exam a patient w/ otitis media will have:
|
Buldging, poorly mobile, opaque tympanic membrane (red/yellow) w/ pain on insufflation
|
|
Otitis media w/ Effusion
|
*Fluid behind TM
*No pn w/ insufflation *Often w/ URI *May be prelude to AOM *May be present up to 1mo post tx of AOM *More common than AOM |
|
What timeline deferrentiates Chronic from Recurrent Otitis media?
|
Chronic lasts >3months
Recurrent 3 episodes of AOM w/in 6mo or 4 episodes w/in 1yr |
|
When diagnosing Otitis media what does COMPT stand for?
|
C= Color of tympanic membrane:Pearly gray= norm
O=Other: fluid, pus, perforations w/ otorrhea M=Mobility:4+=normal P=Position: Neutral vs Full& buldging T= Translucence:Norm= Translcent |
|
Approximately what percentage of AOM cases resolve spontaneously?
|
80%
|
|
Approximately what percentage of AOM cases are resolves w/ abx treatment?
|
94%
|
|
Pain management for Otitis media consists typically of Acetaminophen or Ibuprofen. What are the suggested dosing regimines?
|
APAP: 15mg/kg q6
IBU: 10mg/kg q8: not for kids <6mos |
|
What age group of children are ALWAYS treated with abx for AOM?
|
Children <6mo; benefit outweighs risk
|
|
How do penicillins work?
|
Interfers w/ bacterial cell wall synthesis by binding to penicillin binding proteins
|
|
How do Beta-lactamase inhibitors work?
|
Binds & inhibits beta-lactamase enzyme
|
|
How do Cephalosporins work?
|
Interfers w/ bacterial cell wall synthesis by binding to the penicillin binding proteins
|
|
How do Macrolides work?
|
Inhibits bacterial RNA-dependent protein synthesis by binding to the 50S ribosomal subunit
|
|
How are H. influenzae & M. catarrhalis treated when recognized as pathogen for AOM?
|
Use b-lactamase stable abx: Augmentin, Cefdinir, Cefuroxime & Ceftriaxone
|
|
What is the disadvantage when treating AOM w/ Ceftriaxone?
|
INTRAMUSCULAR INJXN= PAINFUL!!
|
|
What are preventable risk factors for AOM?
|
Lack of breastfeeding
Extended pacifier use |
|
what immunizations are suggested to reduce the risk of AOM?
|
Influenza vaccine & Pneumococcal conjugate vaccine
|
|
What are some clinical exceptions to treatment regimines?
|
*Anatomical abnormalities:Cleft palate
*Genetic conditions: Down's *Immunodeficiency *Cochlear implants *AOM w/in 30days *AOM w/ underlying chronic Otitis media w/ effusion |
|
What are the common bacterial organisms seen w/ pediatric pharyngitis?
|
Group A Strep: Strep pyogenes
Gp C & G Strep: Neisseria gonorroea Corynebacterium diptheriae Haemophilus influenzae Mycoplasma pneumoniae Chlamydia pneumoniae Moraxella caarrhalis Strep. pneumo |
|
What are some common viruses seen w/ pediatric pharyngitis?
|
Rhinovirus
Coronavirus Adenovirus Herpes simplex type 1 & 2 Parainfluenza Enteroviruses- Coxsackie A Epstein Barr virus |
|
GABHS stands for...?
|
Group A Beta-hemolytic Streptococcus
|
|
What is the GOLD STANDARD for testing for GABHS pharyngitis?
|
Rapid Streptococcal antigen detection tests (RADT): Sensitivity= 80-90% & FAST results
|
|
Which Cephalosporins are effective in treatment of pharyngitis?
|
1st & 2nd generation Cephalosporins: Cephalexin, Cefaclor, Cefixime, Cefprozil, Loracarbef
|
|
What are the classifications for Skin and Soft Tissue Infections? (1-4)
|
Class I: Afebrile, previously healthy. Oral or topical abx
Class II: Febrile, ill looking w/ no comorbid conditns. IV or PO ABX Class III:Appears toxic, > unstable comorbidities, limb threatening infxn-Need >1abx typically Class IV: Sepsis, life-threatening infxn or necrotizing fascititis |
|
What are the typical causes of PRIMARY SSTI?
|
*Community acquired/ Gram (+); typicall Staph. aureus or Strep pyogenes
*Other bugs: Pseudomonas, Acinetobacter, Enterobacteraciae, E.coli, Anaerobes |
|
What are the typical causes of Secondary SSTI?
|
*Diabetic foot ulcers, pressure sores--S. aureus, Strep., Bacteroides, Peptostreptococcus, Pseudomonas
*Bites- Animal:Pasturella, S. aureus, Strep., Bacteroides. HUMAN: Eikenella, S. aurueus, Strep. BURNS: Pseudomonas, Enterobacteraceae, Staph. aureus, Strep. |
|
What treatment guidelines were provided for folliculitis?
|
*Warm compress
*Topical agents-Clindamycin, Erythromycin, Mupirocin, Benzoyl peroxide BID-QID X7days |
|
What treatments guidelines were provided for Carbuncles? For Furuncles?
|
*PCNase Resistant PCN-- Dicloxacillin 250mg/q6 x 7-10d or Clindamycin 150-300 mg/q6
*Furuncles- small;moist heat & prompt drainage. Large; same tx as furuncle. |
|
What is Impetigo and what are the treatment options?
|
*Superficial skin infxn usually seen in children; strep pyogenes or staph aureus most common- may resolve spontaneously
*TX: PCNas-Resistant PCN; Dicloxacillin(PEDS) 12.5mg/kg divided Cephalexin, Defadroxil PenG or PenVK or Clindamycin for PCN allergy--150-300mg q6-8 or 10-30mg/kg/day divided |
|
What is CLostridial Myonecrosis?
|
Necrotizing infxn involving skeletal muscle; gas produxn and necrosis
Advances rapidly secondary to trauma or surgery *Clostridum perfringens |
|
What is Necrotizing Fasciitis?
|
Aerobic or anaerobic infxn of superficial fascia or SQ fat
TypeI: Post surgery or trauma; mixed anaerobes & strep or enterobacteraceae TypeII: Virulent strains of Strep pyogenes; rapid necrosis of SQ tissue, gangrene, pn, toxicity-associated w/ shock & organ failure |
|
What are the 3 types of Diabetic foot ulcers?
|
Deep abscess-central plantar space
Dorsum cellulitis-fm infxn of toes Mal perfomas ulcers- Chronic on calluses of metatarsals |
|
What organisms are typically seen with DOG bites?
|
Pasteurella, Staph, Strep, Moraxella, Neisseria, Fusobacterium, Bacteroides, Prevotella, Porphyramonas
|
|
What organisms are typically seen with CAP bites?
|
Pasteurella multocida, Mixed anaerobes, Tularemia, Rabies
|
|
What is Eikenella commononly associated with?
|
IVDA endocarditis; lick needle to lubricate
Gram(-) fastidious slow grower **COMMON w/ human bites** |
|
What type of bugs are generally expected to be seen with diabetic foot infxns?
|
Staph aureus, Strep spp, Pseudomonas, Peptostreptococcus, Bacteroides fragilis
|
|
What 3 things are important for treatment of Diabetic foot infections?
|
1- debridement & cleansing
2- glycemic control 3- ABX tx |
|
What is the typical abx treatment for diabetic foot infections?
|
*Augmentin for mild/ non limb threatening
*Ampicillin/Sulbactam or Imipenem/Cilistatin for more severe **Osteomyelitis requires 6-12 weeks of parenteral tx |