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140 Cards in this Set
- Front
- Back
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Name 2 atypical bacteria
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1. Mycoplasma
2. Chlamydia |
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Name 2 yeasts
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1. Candida
2. Cryptococcus |
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Name 2 molds
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1. Aspergillus
2. Zygomycetes |
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Name 2 dimorphic fungi.
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1. Coccidiodes
2. Blastomyces |
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Name 2 protozoa.
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1. Giardia
2. Plasmodium |
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Name the G+ anearobic cocci.
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1. Peptococcus
2. Peptostreptococcus |
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Name the G+ aerobic cocci found in clusters.
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1. Staph aureus (Coag+)
2. Staph epidermidis (Coag-) 3. Staph saprophyticus (Coag-) |
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Name the G+ aerobic cocci found in pairs/chains that are alpha-hemolytic.
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1. Strep pneumoniae
2. Viridans streptococci |
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Name the G+ aerobic cocci found in pairs/chains that are beta-hemolytic.
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1. Strep pyogenes (A)
2. Strep agalactiae (B) 3. Strep bovis |
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Name the G+ aerobic cocci found in pairs/chains that are non-hemolytic.
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1. Enterococcus faecalis
2. Enterococcus faecium |
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Name the G- cocci.
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1. Neisseria
2. Moraxella |
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Name the G- anaerobic bacilli.
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1. Bacteroides
2. Prevotella 3. Fusobacterium |
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Name the G- aerobic bacilli that are considered fastidious organisms.
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1. Haemophilus
2. Campylobacter 3. Helicobacter 4. Bartonella 5. HACEK organisms |
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Name the G- bacilli that are considered nonfermenters.
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1. Pseudomonas
2. Acinetobacter 3. Stenotrophomonas |
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Name the G- bacilli that are enterics.
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1. E. coli
2. Klebsiella 3. Proteus 4. Shigella 5. Salmonella 6. Citrobacter 7. Enterobacter 8. Serratia |
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Name the 5 normal colonizers of the oral cavity
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1. Peptostreptococcus
2. Eikenella 3. Peptococcus 4. Viridans Strep 5. Haemophilus |
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Name the 4 normal colonizers of the skin.
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1. Staph aureus
2. Staph epidermidis 3. Propionibacterium 4. Corynebacterium |
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Name the 4 normal colonizers of the upper airways.
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1. Strep pneumoniae
2. Strep pyogenes 3. Neisseria 4. H. influenzae 5. Staph aureus (some people are nasal carriers) |
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Name 3 common urinary tract colonizers.
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1. E coli
2. Candida 3. Lactobacillus 4. Streptococcus 5. Corynebacterium |
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Name 5 normal colonizers of the large intestine.
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1. Bacteroides
2. Fusobacterium 3. Clostridium 4. Enterococcus 5. Strep bovis 6. Lactobacillus 7. Coliforms (E coli, enterobacter, citrobacter) |
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This organism is associated with strep throat, necrotizing fasciitis and endocarditis.
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Strep pyogenes.
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This organism is associated with perinatal strep, neonatal sepsis, and colonizes the vaginal canal.
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Strep agalactiae (group B)
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What do you suspect if you find Strep bovis in the blood?
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Colon cancer.
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Where are strep viridans species normally found?
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Mouth, teeth, URT.
Associated with endocarditis |
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What can you quote a patient who insists on an antibiotic, even though you've explained that they have a viral infection?
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1. 1 in 4 chance of diarrhea
2. 1 in 50 chance of skin reaction 3. 1 in 100 chance of ER visit 4. 1 in 4000 chance abx will help URTI. |
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Name the 7 classes of abx that are bacteriocidal in general.
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1. Beta-lactams
2. Monobactams 3. Aminoglycosides 4. Fluoroquinolones 5. Glycopeptides 6. Metronidazole 7. Cyclic lipopeptides |
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Name the 6 classes of abx that are bacteriostatic in general.
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1. Tetracyclines
2. Macrolides/Ketolides 3. Sulfonamides 4. Glycylcyclines 5. Oxazolidinones 6. Lincosamides |
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Give 3 examples of abx classes that are used in a concentration dependent manner.
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1. Aminoglycosides
2. FQ 3. Cyclic lipopeptides |
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Give 3 examples of abx classes that have postantibiotic effects.
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1. AG
2. FQ 3. Cyclic lipopeptides |
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Abx classes that kill microbes at any effective dose above the MIC are time dependent. Give 3 examples.
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1. Beta-lactams
2. Monobactams 3. Vancomycin |
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Name the intracellular organisms.
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1. Chlamydia
2. Legionella |
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Name the 6 abx or classes of abx that are excreted hepatically and do not need renal dosing!
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1. CEFTRIAXONE
2. MACROLIDES/Ketolides 3. METRONIDAZOLE 4. Nafcillin 5. Clindamycin 6. Rifampin |
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When should you adjust for renal dosing?
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Creatinine clearance <60
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Name 3 abxs that can cause transient ototoxicity.
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1. Prolonged high dose Azithromycin, Erythromycin-transient SNHL
2. Minocycline-transient vestibular dysfunction |
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What is the most nephrotoxic antibiotic?
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Aminoglycosides, cause acute tubular necrosis (ATN). Look for muddy brown casts. Will resolve as tubular cells regenerate and replace selves when drug is discontinued.
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What is the most nephrotoxic antimicrobial?
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Amphotericin B, causes ATN.
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What abx is most associated with AIN?
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Acute interstitial nephritis, an inflammation around the tubules, like an allergic reaction.
NAFCILLIN |
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Outdated tetracyclines can cause what nephrotoxic ADR?
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Fanconi Syndrome, a reversible proximal tubule dysfunction that prevents proper reabsorbtion of glomerular filtrate. Results in glucosuria, hyperphosphaturia.
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What is the most likely cause of abx induded psychiatric sxs?
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Fluoroquinolones
Clarithromycin TMP-SMX Metronidazole INH |
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What is the most common cause of abx induced phlebitis?
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NAFCILLIN
Cefepime Vancomycin Clindamycin |
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Describe a disulfiram-like reaction. What is the most common abx cause?
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Flushing, N/V/D, abd cramping, tachycardia, HA
METRONIDAZOLE also beta lactams with an MTT or MTT-like side chain (cefazolin) |
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What causes red man syndrome?
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Histamine release from too rapid infusion of vancomycin. Give slower or with diphenhydramine.
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Why would concurrent contact lens use and rifampin administration be a bad idea?
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Red lobster syndrome- urine, sweat, tears turn red from rifampin, permanently discolors lenses.
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Why are TTCs contraindicated in kids <8 years old?
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They turn developing teeth brown/green.
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What abx is associated with loss of red/green color perception?
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Ethambutol, can cause optic neuritis.
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Why is bactrim contraindicated in 3rd term pregnant women and neonates?
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Sulfonamides cross placenta and may displace bilirubin from albumin, leading to kernicterus.
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Name an abx that can cause:
1. Hyperkalemia 2. Hypokalemia |
1. TMP-SMX, blocks distal tubular reabsorption of Na, excretion of K
2. Various PCNs, act like nonabsorbed anions, draw K out into urine. |
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Abx with the highest incidence (risk of developing) of CDAD
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Clindamycin
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Abx associated with the highest prevalence (# of cases) of CDAD
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Oral aminopenicillins
Oral cephalosporins |
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What is the most common reaction to treatment of EBV with ampicillin?
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Rash.
(can be any aminopenicillin) |
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What abx do you really want to avoid in pregnancy?
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Metronidazole in first trimester only
AG-ototoxicity TTC-tooth/bone probs, hepatotoxic to mom Sulfonamides-kernicterus FQ-arthropathies |
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What PCN relative can you substitute when a pt has an anaphylactic allergy to PCNs?
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Aztreonam
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What are your top three ideal PO choices for treating MSSA?
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1. Dicloxacillin
2. Cephalexin 3. Doxycycline or Bactrim or Clindamycin |
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What are your top 2 PO choices for treating MRSA?
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1. Linezolid
2. Doxycycline |
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Best PO choice to treat Pseudomonas?
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FQ- cipro and levofloxacin
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Best PO choice to treat VRE?
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Linezolid
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Best PO choice to treat mixed aerobic and anaerobic infections?
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1. Metronidazole or Augmentin
2. Clindamycin |
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Best IV choice to treat MSSA?
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1. Nafcillin
2. Cefazolin 3. Vancomycin |
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Best IV choice to treat MRSA?
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1. Vancomycin
2. Linezolid, Tigecycline, Daptomycin |
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You will have to check the susceptibility of the strain in your hospital, but what might you use IV to treat pseudomonas?
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1. Piperacillin/Tazobactam
2. Aztreonam 3. Ceftazidime 4. Cipro or Levofloxacin 5. Tobramycin 6. Doripenem |
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Best IV treatment for VRE?
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Linezolid, Daptomycin or Tigecycline
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Best IV treatment for anaerobic infections?
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1. Pip/Tazo or Carbapenems or Metronidazole
2. Clindamycin |
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Describe the MOA of Beta-lactams, and what is the condition for bactericidal effect?
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PCNs bind to PBP and disrupt cell wall synthesis. Cells must be actively dividing!
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Nafcillin, though best IV treatment for MSSA, can be problematic. What are the 3 most common ADRs associated with nafcillin?
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1. AIN
2. Phlebitis 3. hypokalemia |
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Name 4 common treatment indications for aminopenicillins.
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1. URTIs (OM, sinusitis, pharyngitis)
2. Strep skin infections 3. Dental prophylaxis for endocarditis 4. Lyme disease |
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Aminopenicillins
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Amoxicillin (PO)
Ampicillin (IV) |
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Natural PCNS
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Pen VK (PO)
Pen G (IV) |
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Unasyn
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Ampicillin/Sulbactam (IV)
same coverage as aminopenicillins plus extended respiratory organisms: M. cat, H. flu, some E coli, Klebsiella |
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Augmentin
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Amoxicillin/Clavulanate
Same coverage as aminopenicillins plus extended gram neg respiratory organism coverage: M. cat, H.flu, some E. coli and Klebsiella |
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Name 3 of the most common indications to use an augmented aminopenicillin.
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1. Animal/human bite
2. Amox failure to treat OM, pharyngitis, sinusitis 3. Dental infections |
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Zosyn
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"Extended spectrum PCNs"
Piperacillin/Tazobactam Mostly used in nosocomial infections. Gets pseudomonas, NOT MRSA |
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First generation Cephalosporin
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Cephalexin (Keflex) PO
Cefazolin (Ancef) IV |
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Second generation cephalosporin
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Cefuroxime (Ceftin) PO
Cefuroxime (Zinacef) IV |
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Third generation cephalosporin
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Cefpodoxime (Vantin) PO
Ceftriaxone (Rocephin) IV/IM |
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Fourth generation cephalosporin
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Ceftazidime (Fortaz) IV
Cefepime (Maxipime) IV |
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What ADR related to ceftriaxone makes it unsafe for pregnant women?
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Biliary sludging (pseudocholelithiasis). Drug builds up in CBD, precipitates with calcium
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What cephalosporin can cause serum-sickness like reaction?
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Cefaclor (2nd gen cephalosporin)
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Cephalosporins in general have good gram positive coverage that decreases with advanced generations, while gaining gram negative coverage. It is important to know that no cephalosporin covers these 2 gram positive organisms.
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Listeria
Enterococci |
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Name 3 common indications for first generation cephalosporins.
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1. SSTIs
2. Preop prophylaxis 3. Streptococcal pharyngitis 4. Lower UTI |
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Second generation cephalosporins cover everything the first did, with the addition of what 3 respiratory organisms?
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1. PNEUMOCOCCUS
2. M.cat 3. H.flu *and pasteurella |
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Name 3 common indications for 2nd gen cephalosporins.
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1. Amox failure URTIs
2. SSTIs 3. Lower UTI |
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Name 3 of the most common indications for 3rd gen cephalosporins
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1. Gonorrhea (cefixime PO or ceftriaxone IM)
2. Meningitis 3. CAP (along with azithromycin) |
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When would you be most likely to use a 4th gen cephalosporin?
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Nosocomial infection.
These get pseudomonas, enterobacter, serratia |
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The only monobactam is aztreonam. What is it indicated for?
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Alternative when pt has anaphylactic rxn to PCN
Nosocomial infections: gets most resistant GNB, including pseudomonas |
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Pseudomonal Carbapenems
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1. Imipenem (Primaxin)
2. Doripenem (Doribax) 3. Meropenem (Merrem) |
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Non-Pseudomonal Carbapenems
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Ertapenem (Invanz)
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When do you pull out carbapenems?
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Nosocomial infections, complicated with resistant organisms, gram negatives.
DOES NOT COVER C.dif, MRSA, VRE! |
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What is the MOA of glycopeptides?
Name the family members. |
Inhibit cell wall synthesis
Vancomycin |
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When is the only time you would used PO vancomycin?
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CDAD. Is not absorbed in the gut! Will not reach any other area in the body.
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Dosing for this abx is based on ideal body weight and must be monitored carefully for trough levels.
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Vancomycin
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Name an indication for vancomycin besides treatment of MRSA.
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MSSA, strep species, enterococci in pt allergic to PCN
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Describe the MOA of tetracyclines. What is unique about MOR to this family?
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Protein synthesis inhibitor, bacteristatic.
Efflux pumps kick drug back out of cell |
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Why should you never combine a tetracycline with isotretinoin?
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Pseudotumor cerebri (increased ICP)
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What absorption issues should you consider when giving directions to the patient taking a tetracycline?
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Taking with multivalent cations will decrease absorption. Do not take with milk or multivitamins, iron supplements.
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Name 3 common indications to use a tetracycline.
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1. URTI
2. CAP 3. Tick borne disease (lyme, rickettsia, ehrlichosis) 4. Non-gonococcal urethritis (chlamydia) |
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Glycylcyclines
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Tigecycline (Tygacil)
bacteriostatic derivative of minocycline |
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When would you use a glycylcycline?
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Noscomial infections. Very broad coverage
DOES NOT GET PSEUDOMONAS |
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Macrolides
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Azithromycin (Zithromax)
Clarithromycin (Biaxin) Erythromycin-don't use! unless for gastric motility |
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What is the MOA of macrolides? What is unique about MOR to this family?
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Protein synthesis inhibitor
bacteriostatic Efflux pumps |
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What are the major interactions to look out for when prescribing clarithromycin?
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Potent 3A4 inhibitor
Prolongs QT interval has a metallic taste |
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Name the 3 most common indications for macrolides
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1. URTIs
2. NGU (azithromycin for chlamydia) 3. CAP (gets M.cat, H.flu, Pneumococcus, legionella, mycoplasma) |
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Ketolides
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Telithromycin (Ketek) PO
supercharged erythromycin-shouldn't be using this... |
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The only ketolide on the market right now will likely be withdrawn soon due to?
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Hepatotoxicity and acute liver failure
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Lincosamides
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Clindamycin (Cleocin) PO,IV
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What is the MOA of lincosamides? What is unique about MOR to these?
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Protein synthesis inhibition
efflux pumps |
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Name 3 common indications for clindamycin
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Best "above the diaphragm"
1. SSTIs and strep pharyngitis in PCN allergic pts 2. Anaerobic infections, abscesses (plus beta-lactam or FQ) (penetrates almost every tissue in the body except BBB) |
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Oxazolidinones
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Linezolid (Zyvox) PO/IV
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What are the 2 main interactions/ADRs to worry about with linezolid?
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It is serotonergic, reversibly inhibits MAO
May cause reversible thrombocytopenia. Monitor pts who will be on linezolid >2weeks |
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What should linezolid be used for?
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MRSA (remember is not cidal)
VRE |
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Aminoglycosides
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Gentamicin (topical, IV)
Tobramycin (topical, IV) others... |
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Describe the MOA of aminoglycosides, and 2 MORs associated.
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Protein synthesis inhibitor
Efflux pumps aminoglycosidases |
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How can ototoxicity and nephrotoxicity be minimized with AG administration?
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Killing is concentration dependent, but toxicities are time dependent. Hit fast and hard, take advantage of postantibiotic effect
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Name 2 common indications for gentamicin
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1. "severe infection" involving aerobic GNB
2. Synergistic killing of enterococci and S. aureus, ie for ENDOCARDITIS |
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Name an indication for tobramycin.
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Most severe GNB infections, including PSEUDOMONAS
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Respiratory FQs
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Levofloxacin (Levaquin) PO/IV
Moxifloxacin (Avelox) PO/IV |
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Non-Respiratory FQs
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Ciprofloxacin (Cipro) PO/IV
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What is the MOA of FQs?
MOR? |
Inhibition of topoisomerases
efflux pump |
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Name 3 interactions/ADRs to watch out for when prescribing FQs.
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1. Prolong QT
2. Clinically may raise INR 3. Multivalent cations decrease absorption 4. Arthropathies, cartilage erosions in kids (?) 5. Achilles tendon rupture in elderly and pts on steroids 6. Hallucinations, delerium |
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When would you use a non-respiratory FQ?
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"below the belt", gets Pseudomonas
1. Upper and Lower UTI 2. Enteric infection, TravD |
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Name the 2 most common indications for respiratory FQ.
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1. Upper and lower UTI (not moxifloxacin)
2. Upper and lower resp tract infections |
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What is the MOA of TMP-SMX?
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inhibits folate synthesis
bacteriostatic |
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Name 3 interactions/ADRs to watch out for when prescribing TMP-SMX
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1. Inhibits CYP2C9, can raise INR
2. Reversible myelosuppression 3. Hemolytic anemia in G6PD patients |
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Name 3 common indications for bactrim.
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1. URTIs
2. Lower UTIs (second line therapy) 3. PCP prophylaxis/treatment 4. MRSA skin abscess |
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Cyclic lipopeptides
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Daptomycin (Cubicin) IV
bactericidal |
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What is the MOA of cyclic lipopeptides? What is the main ADR associated with daptomycin?
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"punches hole in cell wall"
Myopathy, caution with statins |
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When would you use daptomycin?
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1.MRSA and VRE
2. MSSA, strep, enterococci in PCN allergic pts |
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Nitroimidazoles
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Metronidazole (Flagyl) PO/IV/topical
Tinidazole (Tindamax) PO |
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What is the MOA of nitroimidazoles?
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"interferes with DNA"
bactericidal |
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Name 3 common indications for metronidazole.
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Anaerobes "below the diaphragm"
1. BV 2. C.dif 3. Giardiasis, Trichomoniasis |
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Nitrofurans
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Nitrofurantoin (Macrobid) PO
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Name the 2 main ADRs associated with nitrofurantoin
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1. pulmonary fibrosis
2. probs in pts with G6PD deficiency |
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Name an indication for nitrofurantoin.
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Uncomplicated UTI, prophylaxis for recurrent UTI.
*not for pyelo, does not penetrate renal tissue |
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What might you use Rifaximin (Xifaxan), a derivative of Rifampin, for?
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NONinflammatory diarrhea caused by E.coli, ie in travelers.
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Chloramphenicol is an abx with bad ADRs like myelosuppression and potentially fatal aplastic anemia. What would you use it for?
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Last resort in CNS infections
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What is Mupiricin (Bactroban) topical abx used for?
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MRSA colonization in the nose
Skin abscess, impetigo |
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Pleuromutilins
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Retapamulin (Altabax) oint.
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What would you use retapamulin for?
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Alternative to bactroban:
MSSA bullous/nonbullous impetigo MRSA colonization in nose *may be less irritating than bactroban, compounded in petrolatum instead of polyethylene glycol |
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Name the 4 meds we use as first line therapy for mycobacterium.
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1. Isoniazid (INH)-drug of choice for latent TB
2. Rifampin (RIF) 3. Ethambutol (ETH) 4. Pyrazinamide (PZA) |
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Remember that isoniazid is metabolized by NAT. What happens with "fast" and "slow" acetylators?
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Fast: more likely to get hepatitis
Slow: more likely to get drug-induced lupus and peripheral neuropathy (some prevention with vit B6) |
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Why wouldn't you ever use rifampin by itself to treat an infection?
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Resistance to rifampin develops in 1-2 days.
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