Id

Front 1

lowest drug concentration that prevents visable microbial growth after a 24 hr incubation

Back 1

MIC (minimum inhibitory concentration)

Front 2

level of MIC at which a bacterium is deemed either susceptible or resistant to an antibiotic (vary for diff classes)

Back 2

Breakpoint

Front 3

Who establishes breakpts?

Back 3

FDA+Clinical and Lab Standards Institute (CLSI)

Front 4

lowest drug concentration that reduces bacterial density by 99.9% in 24 hours

Back 4

MBC (minimum bactericidal concentration)

Front 5

effect of 2+ agents combined to produce a greater effect than the sum of their indv effects

Back 5

Synergy

Front 6

optimal sel, dosage, route of admin, and duration of antimicrobial treatment that results in the best clinical outcome

Back 6

Antimicrobial stewardship programs

Front 7

Common aspects of antimicrobial stewardship programs (4)

Back 7

1. oversee guideline development

2. restriction/pre-auth policy

3. automatic IV:PO med interchange

4. De-escelation or streamlining of therapy based on pt response and culture/susceptibility results

Front 8

chart that contains susceptibility patters of local bacterial isolates to antimicrobial agents at a single institution over a specific pd of time

Back 8

antibiogram

Front 9

have enhanced tissue penetration to bone, lung, brain

Back 9

lipophilic antimicrobials

Front 10

- on a susceptibility report indicates ___

Back 10

drug was not tested against the bacteria (does NOT mean resistance!!)

Front 11

lipophilic agents (6)

Back 11

1. FQ

2. macrolides

3. rifampin

4. linezolid

5. tetracyclines

6. chloramphenicol

Front 12

These agents have hepatic metabolism and toxicity

Back 12

lipophilic agents

Front 13

These agents have renal metabolism and toxicity

Back 13

hydrophilic agents

Front 14

PO:IV ratio of lipophilic agents

Back 14

1:1

Front 15

Active against atypicals (ITC)

Back 15

lipophilic agetns

Front 16

dosed more frequently to maximize time above MIC b/c r time-dept

Back 16

beta lactam

Front 17

concentration dept agents = dosed less freq + higher doses to maximize conc above MIC (3)

Back 17

aminoglycosides, FQs, daptomycin

Front 18

numerous studies have documented that extended/cont infusion of these can reduce length of stay, mortality, and costs, particulary when treating gram negative pathogens like Pseudomonas

Back 18

b-lactams

Front 19

T/F: bactericidal activity with mild infections (not immunocomp or endocarditis), does NOT imply improved pt outcomes

Back 19

TRUE

Front 20

1. DOC for perioperative px

2. how long is it initiated b4 surgery?

Back 20

1. first or second gen cephlosporins: cefazolin

2. w/i 1 hr (can be given rapidly just prior)

Front 21

1. When is vancomycin used for periop px? (2)

2. How long b4 surgery is vanc admin? why?

Back 21

1. a. MRSA concern

b. b-lactam allergy

2. 2 hrs before incision (FQs are also given 2 hrs b4) - to avoid AE

Front 22

What can be used for colon or bowel surgeries? (3)

Back 22

(high risk anaerobic infection - use broader coverage:)

1. cefotetan

2. ertapenem

3. ceftriaxone + metronidazole

Front 23

1. meningitis triad symptoms

2. do ALL pts develop all 3 symptoms?

Back 23

1. a. severe HA

b. nuchal rigidity (neck)

c. altered mental status

...all due to meningue swelling

2. NO (others: chills, vomiting, photopobia)

Front 24

Most common cause of meningitis

Back 24

viral

Front 25

1. What is required for pts suspected of bacterial meningitis?

2. Should abx be dealyed until results come back from LP?

Back 25

1. lumbar puncture

2. NO!!!

Front 26

must be maximied to optimize CNS pentration

Back 26

abx dosages

Front 27

T/F: with meningitis, likely pathogens and empiric abx sel depends on pt age

Back 27

True

Front 28

1. most likely meningitis pathogen in 2-50 yo

2. tx

Back 28

1. S. pneumo and N. meningitis

2. a. cefotaxime 2 gram q 4-6 hr

b. ceftriazone 2 gram q 12 hr

c. meropenem 2 g q 8 hr

+ vancomycin 30-45 mg/kg/day divided

+/- dexametasone 0.15 mg/kg IV q6 hr x 2-4 days

+ ampicilliin 2g q4 hr (if <1 mo. or >50 yo, suspected Listeria)

Front 29

DOT for meningitis

Back 29

1-2 weeks

Front 30

1. most likely meningitis pathogen in >50 yo

2. tx

Back 30

1. S. penumo, N. meningitis, L. monocytogenes

2. vanc + ampicillin + ceftriaxone/cefotaxime

Front 31

What are options for meningitis in PCN allergy?

Back 31

chloramphenicol + vanc +/-Bactrim (for Listeria)

Front 32

What would be the CSF trend in meningitis?

Back 32

1. LOW glucose

2. high WBC

3. high protein

Front 33

most common childhood infection in US

Back 33

AOM (acute ititis media)

Front 34

What is otorrhea?

Back 34

middle ear effusion/fluid

Front 35

What is otalgia?

Back 35

ear pain

Front 36

what is the most common cause of AOM?

Back 36

viral

Front 37

Tx for AOM?

Back 37

1. pain: APAP or ibuprofen...topicals: benzocaine, procaine, lidocaine in children >5 yrs

2. Abx

Front 38

1. Who may be observed?

2. How long?

Back 38

1. NO otorrhea or severe symptoms: unilateral or bilateral and >2 yo

2. 2-3 days

Front 39

1. First line abx for AOM

2. tx duration

Back 39

1. in 2 div doses:

a. amox 80-90 mg/kg/day

b. Augmentin 90 mg/kg/day + 6.4 mg/kg/day clav

2. <2 yo: 10 days

2-5 yo: 7 days

>5 yo: 5-7 days

Front 40

Alterv if PCN allergy for AOM

Back 40

cefdinir, cefuroxime, cefpodoxime, ceftriaxone

Front 41

Risk with high clavulaonate levels

Back 41

GI AE - best to use amox 600 mg/42.9 mg clav/5 ml (Augmentin ES 600)

Front 42

Option if pt cannot tolerate oral med due to GI AE?

Back 42

ceftriaxone 1-3 days (1 day for tx initial and 3 if tx failure)

Front 43

1. When do children recieve Prevnar?

2. ADULT vaccine with 23 serotypes? Who else should receive?

Back 43

1. 2, 4, 6, 12-15 mo.

2. Pneumovax: also give to children >2 yo who are immunocompromised

Front 44

When should children start receiving flu vaccine?

Back 44

>6 mo

Front 45

Should Drs prescribe px abx for AOM?

Back 45

NOOO!

Front 46

fluid+infl in middle ear WITHOUT s/s acute inf

Back 46

otitis media WITH effusion (OME)

Front 47

rapid onset s/s infl + effusion in middle ear

Back 47

AOM - MUST be <2 day onset s/s

Front 48

What causes the majority of URTIs (common cold, flu, pharyngitis, sinusitis)?

Back 48

viruses

Front 49

1. When can oseltamivir or zanamavir be given for flu?

2. tx duration

Back 49

1. <48 hrs since symptom onset, RF for severe dx

2. x 5 days

Front 50

Possible bacterial pathogen causing pharyngitis

Back 50

S. pyogenes

Front 51

1. When can abx be given for pharyngitis?

3. tx

2. duration

Back 51

1. + culture for S. pyogenes

2. PCN, amoxicillin, 1/2 gen ceph (allergy: clarithro/azithro/clinda)

2. x 10 days (azithro x 5 days)

Front 52

Caused by rhinovirus, coronavirus, RSV

Back 52

common cold

Front 53

if bacterial, caused by S. pneumo, H flu, morexalla catarrhalis, staph anaerobes, gram neg rods

Back 53

sinusitis

Front 54

1. indications for sinusitis tx (4)

2. First line tx

Back 54

1. a. >1 wk symptoms
b. tooth/face pain
c. nasal discharge/drainage
d. congestion or severe/worsening symptom

2. Augmentin or doxy (x~7 days)

Front 55

LRTIs

Back 55

1. bronchitis

2. pneumonia

3. TB

Front 56

catogories bronchitis

Back 56

1. acute - viral cause, self-limiting (cough,sore throat low fever, HA, malaise, etc)

**expect cough to last 2 weeks

2. chronic

Front 57

Tx for acute bacterial exacerbation of chronic brochintis

Back 57

inhaled anticholinergic (ipratropium/tiotropium) + oral corticosteriod x 2 weeks (including taper)

Front 58

Bacterial causes of CAP (3)

Back 58

1. Strep pneumo

2. H. flu

3. Morazella catarrhalis

Front 59

S/s CAP

Back 59

1. fever

2. prod cough + purulent sputum + chest pain

3. rales

Front 60

Gold standard for CAP dx

Back 60

chest x-ray

Front 61

Tx CAP: outpt vs inpt

Back 61

1. outpt:

a. healthy/no abx in past 3 mo:

macrolide OR doxycycline

b. abx or comorb/immunosup OR inpt - nonICU:

macrolide + b-lactam OR resp FQ = MGL

2. ICU: IV b-lactam + azithro/FQ

allergy: FW + aztreonam

Front 62

What is CA-MRSA concern?

Back 62

add vanc/linezolid

Front 63

leading cause of infectious death in ICU

Back 63

HAP

Front 64

Most common causes of HAP <5 days after admit (early onset)

Back 64

same as CAP + more gram neg bacteria + atypicals (Legionella, Mycoplasma)

Front 65

Most common causes of HAP >5 days after admit (late onset)

Back 65

MRSA, pseudomonas

Front 66

Tx early onset HAP

Back 66

cetriatone, Unasyn, ertapenem, or Resp FQ

Front 67

Tx late onset HAP

Back 67

1. b-lactam with antipseudomonal coverage: cefepime,ceftrazidime, imipenem/meropenem/pip/tazo

2. gentamicin/tobramycin/amikacin/levoflox/cipro

3. MRSA RF: + vanc/linazolid

Front 68

HAP duration tx

Back 68

7-8 days (unless penudomonas or acinetobacteria or bacteremia: x 2 wks)

Front 69

Cuased by mycobacterium tuberulosis

Back 69

TB

Front 70

2 phases TB

Back 70

1. latent: NO symptoms

2. active - coughing, fever, purulent sputum

Front 71

diagnosied by TST (tuberculin skin test) = PPD (purified protein derivative test)

Back 71

LATENT TB

Front 72

When is area inspected after PPD?

Back 72

2-3 days later

Front 73

= positive PPD for all pts

Back 73

TST>15 mm

Front 74

Latent TB tx

Back 74

1. isoniazid 300 mg BWk x 9 mo

OR 2. rifampin 400 mg QD x 4 mo.

OR 3. INH + rifapentine qwk x 3 mo.

Front 75

Is rafampin + pyrazinamide regimen used?

Back 75

NO - hepatotoxic

Front 76

Is active TB dx with a TST?

Back 76

NO - via sputum sample

Front 77

acid fast bacilli, anerobic, NON-spore

Back 77

Mycobacterium tuberculosis

Front 78

Is MTB lab stain conculsive for MTB?

Back 78

NO- non-sp - must use PCR or culture results

Front 79

Tx TB active dx

Back 79

4 drug regiment:

RIPE: rifampin, INH, pyrazinamide, ethambutol

Front 80

When is the PRIME regimen used?

Back 80

= add moxifloxacin, use if MDR-TB is a concern

Front 81

1. How long is the initial tx phase for active TB?

2. tx cont phase

Back 81

1. x 2 mo. - until cultures come back, then narrow tx

2.

a. if susceptible: INH + RIF x bWk for 18 more wks

b. if resitant to INH: all others + moxi for 18 more weeks, etc

if sint suseptable to INH: add FQ for 1 yr - 18 mo

Front 82

carries neuropathy risk, which can be reduced by pyridoxine intake = Vit B6 25-50 mg PO QD

Back 82

INH

Front 83

When if rifabutin used instead of rifampinI?

Back 83

if pt taking PI (CI)

Front 84

Must be taken on empty stomach (2) - 1 hr BEFORE, or 2 hrs POST meals

Back 84

1. INH
2. rifampin

Front 85

causes increased LFTs, rash/prutitus, orange-red body secretions, flu-like syndrome

Back 85

rifampin

Front 86

BBW heaptitis

Back 86

INH

Front 87

AE: GI upset (2)

Back 87

1. INH

2. pyrazinamide

Front 88

AE: increased LFTs

Back 88

INH, rifampin

Front 89

Can cause DILE

Back 89

INH

Front 90

+ Coombs test

Back 90

1. Rifampin

2. INH

Front 91

risk hyperuricemia, gout

Back 91

pyrazinamide

Front 92

rsik optic neurits, must have routine vision tests

Back 92

ethambutol

Front 93

indicated for MDR-TB

Back 93

bedauiline - QT prolongation BBW!!

Front 94

Streptomycin can increase __ toxicity

Back 94

nephro

Front 95

most prevalent infection on the planet

Back 95

TB

Front 96

Treatment for TB should always include an adherence plan that emphasizes ___

Back 96

DOT = directly observed therapy

Front 97

symptoms infective endocarditis (IE)

Back 97

fever + heart murmur

Front 98

Most common organisms causing IE

Back 98

1. Staph

2. Strep

3. Enterococcus

Front 99

How is IE dx?

Back 99

modified Duke criteria - includes echo

Front 100

emperic tx IE

Back 100

vanco + ceftriaxone

Front 101

Should extended interval dosing be used when treating endocarditis?

Back 101

NO!!

Front 102

What is the synergistic target peak and trough for gentamicin in IE

Back 102

1. peak: 3-4 mcg/ml

2. torugh <1 mcg/ml

Front 103

Who should recieve px abx before dental procedures to prevent IE?

Back 103

1. prosthetic heart valve

2. hx IE

3. heart transplant

4. congenital heart defects

Front 104

PX regiment for IE dental procedue

Back 104

1. amoxicillin 2 g PO

2. allergy: clinda 600 mg OR azithro/clarithro 500 mg

Front 105

Second most common cause inf mortality in ICUs

Back 105

intra-abdominal inf

Front 106

catogories intra-abdominal inf

Back 106

1. primary peritonitous (spontaneous)

2. secondary

3. tertiary peritonitis

4. biliary tract (cholecystitis and cholantitis)

Front 107

Who is most likely to develop primary SBP/primary peritonitous, tx

Back 107

liver dx pts - tx: ceftiraxone x 5-7 days

Front 108

Intra-abdominal inf caused by traumatic events (ulceration, ischemia, obstruction, surgery)

Back 108

secondary, tx: drain abscess

Front 109

infection of gallbladder

Back 109

cholecystitis - surgically managed

Front 110

primary skin and soft tissue infections

Back 110

cellulitis and impetigo

Front 111

infection that affects ALL layer of skin

Back 111

cellulitis

Front 112

tx non-purulent cellulitis

Back 112

b-lactam

Front 113

tx purulent celllulitis

Back 113

clinda/TMP/SMX/doxy

Front 114

What can be used to treat recurent SSTIs in pts with nasal MRSA colonization?

Back 114

intranasal mupirocin (Bactroban) BID x 5 days

Front 115

pus that extends into subQ tissue

Back 115

furuncle

Front 116

UTI most common

Back 116

cystitis: bladder and urethra (lower urinary tract)

Front 117

most severe UTI

Back 117

upper urinary tract: pyelonephritis (kidneys)

Front 118

Why are UTIs more common in women?

Back 118

shorter urethra (shorter route for organisms to travel)

Front 119

s/s UTI

Back 119

1.dysuria

2. urgency

3. freq

4. burning

5. suprapubic heaviness

6. hematuria

+ urinalysis with pyuria + baceriuria

Front 120

Is fever a common UTI symptom?

Back 120

NO

Front 121

When is fever a symptom of UTI?

Back 121

pylenonephritis - along with flank and abdominal pain, N/V, etc

Front 122

1. Who is always treated for UTI, even if asymp with negative urinalysis?

2. duration

Back 122

1. preganant women - Augmentin or oral ceph

2. x1 wk

Front 123

Can cause cartilage tox and arthropathies if used in pregancy

Back 123

quinolones

Front 124

can cause hyperbilirubin + kernicterus in 3rd trimester

Back 124

bactrim

Front 125

urinary analgesis

Back 125

phenazopyridine

Front 126

AE phenazopyridine

Back 126

1. HA/dizziness

2. stomach cramps

3. red-orange coloring body fluids

Front 127

Azo, Urisat, Pyridium

Back 127

phenazopyridine

Front 128

What can be done to minimize GI upset with Azo?

Back 128

take w/ food + 8 oz water

Front 129

Tx acute, uncomplicated cystitis

Back 129

nitrofurantoin x 5 days (second line: DS bactrim x 3 days)

...both: BID

Front 130

Difference b/t tx of complicated and uncomp UTI therapy

Back 130

DURATION - for complicated: 10-14 days

Front 131

Tx pylenonephritis

Back 131

FQ: cipro, levo ONLY

Front 132

symptoms include abdominal cramps, bloody, soft, or water stool, fever

Back 132

C diff inf

Front 133

causes of toxic megacolon

Back 133

C. diff (causing pseudomembrainous colitis)

Front 134

Are probiotics beneficial for c. diff tx?

Back 134

NO - only for px

Front 135

What should be AVOIDED with CDI

Back 135

antimotility agents (risk toxic megacolon)

Front 136

Tx C. diff: mild-mod

Back 136

metronidazole TID 500 mg x 10-14 days

Front 137

tx c. diff: severe of 3rd occurrence

Back 137

vanc x 10-14 days (with 3rd occurrence: use vanc TAPER)

Front 138

most common travel-related illness

Back 138

traveler's diarrhea