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50 Cards in this Set

  • Front
  • Back
Penicillins
Bacteriocidal
Absorption: variable, depending on side chain
Dist: wide, not CSF
Metabolism: some hepatic, t1/2: 30-60 min
Excretion: rapidly by kidney (glom/tub) - except Nafcillin & Oxacillin
Adverse reactions: GI, superinfections, seizures at high dose, hypersensitivity (incl anaphylaxis)
Penicillin G
Narrow spectrum (G+)
B-lactamase sensitive
Pareneteral
Streptococcal
Penicillin V
Narrow spectrum (G+)
B-lactamase sensitive
Oral
Streptococcal
Methicillin
Narrow spectrum (G+)
B-lactamase resistant
Parenteral
Staph aureus
Nafcillin
Narrow spectrum (G+)
B-lactamase resistant
Parenteral
Staph aureus
*not excreted renally
Oxacillin, cloxacillin, dicloxacillin
Narrow spectrum (G+)
B-lactamase resistant
Oral
Staph aureus
*Oxacillin not excreted renally
Ampicillin, Amoxicillin
Extended spectrum (G+, some G-)
B-lactamase sensitive
Oral
E. coli
Ticarcillin
Extended spectrum (G+, some G-)
B-lactamase sensitive
Parenteral
Pseudomonas aeruginosa
Mezlocillin
Extended spectrum (G+, some G-)
B-lactamase sensitive
Parenteral
Pseudomonas aeruginosa
Piperacillin
Extended spectrum (G+, some G-)
B-lactamase sensitive
Parenteral
Pseudomonas aeruginosa
Benzathine or Procaine Penicillin G
Delayed absorption penicillins
Clinical use: streptococcal pharyngitis, Syphilis

Narrow spectrum (G+)
B-lactamase sensitive
Parenteral
Augmentin
Amoxicillin + Clauvulanic Acid
Tx: Otitis media, Sinusitis
- Staph aureus
Timentin
Ticarcillin + Clauvulanic Acid
Tx. Staph aureus, bacteriodes
Unasyn
Ampicillin + Sulbactam
Tx. Staph auerus, E. coli
Zosyn
Piperacillin + Taxobactam
Tx. Complicated skin infections, intraabdominal infections
Cephalosporins
Bacteriocidal
Absorption: Oral for 1st, 2nd, 3rd gen
Distribution: well dist; 3rd and 4th --> CSF
Metabolism: varies, usually minimal; t1/2=0.5-8hr
Excretion: renal, some hepatic
Adverse reactions:
- pain at injection site, phlebitis (IV), GI upset, kidney damage at high doses
1st Generation Cephalosporin
G+ >> G-
Oral
Clinical use: Staph, Strep, E. coli
2nd Generation Cephalosporin
G+ ~ G-
Oral
Clinical Use: E. coli, Klebsiella, Proteus
3rd Generation Cephalosporin
G- > G+
More resistant to B-lactamases
Clinical uses: Strep pneumonaie, N. gonorrhea, N. meningitides, Pseudomonas aeruginosa
Cefepime
4th Generation Cephalosporin
Increased stability against B-lactamases
G+ and G-
Tx: Pseudomonas aeruginosa, Neutropenic fever
Ceftaroline
Newest class of cephalosporin
Can bind PBP2a - MRSA has sensitivity
Absorption: IM/IV
Well dist
Metabolism: admin as phosphate, converted by plasma phosphatases; t1/2: 2.6 hours
Excretion: primarily renal
Cefotetan
Methylthiotetrazole Ring
can cause bleeding disorders by interfering with vitamin K dependent clotting
Disulfram-like action: interfering with alcohol metabolism
Aztreonam
Cephalosporin (own class) - "mono bactam"
Very narrow spectrum: G- aerobes only
Resistant to B-lactamases
Non-nephrotoxic, non-ototoxic alternative to aminoglycosides
Diphtheria Toxin
Only lysogenized Corynebacteria
ADP-ribosylates EF2 inhibiting protein synthesis and kills host cell
DtxR: repressor, must be bound to Fe
Carbapenems
Bacteriocidal
Inhibit PBPs (B-lactams)
Broad spectrum of activity: G+/G-
Absorption: Parenteral
Distribution: Most tissue/fluids, CSF if meninges are inflamed
Metabolism: Imipenem hydrolyzed in kidney (+Cilastatin)
Imipenem & Meropenem: t1/2 = 1 hr
Ertapenem: t1/2 = 4 hour
Excretion: primarily renal

Uses:
complicated intraabdominal infections and UTIs
Polymicrobial infections
Pseudomona aeruginosa
Neutropenic fever

*Meropenem - Bacterial meningitis

Adverse effects: GI, hypersensitivity, injection site irritation, headache (Ertapenem), seizures (imipenem)

Drug interaction: decreases amount of Valproic Acid (used for tx seizures)
Vancomycin
Bacteriocidal
Absorption: IV, oral for C diff
Distribution: well diet, CSF if meninges inflamed
Metabolism: little, t1/2 = 6 hr
Excretion: glomerular filtration
Uses: HA-MRSA, C diff
Adverse effects: hypersensitivity (anaphlaxis rare), nephrotox/ototox (high dose), Red Man Syndrome (if infused too quickly)
Daptomycin
Bacteriocidal
Absorption: IV (polyanionic)
Distribution: plasma, ISF; not CSF
Metabolism; little; t1/2: 8.1 hr
Excretion: primarily renal
Uses: complicated skin and soft tissue infection (VISA, VRSA)
Adverse effects: GI irritation, elevated CK
- better if more time between doses
- increases with statin use
Aminoglycosides
Bacteriocidal
Gram-
Absorption: parenteral, usually IV
Dist: primary ECF, can attain high con in inner ear and renal cortex
Metabolism: little; t1/2 = 2-3 hours
Excretion: glomerular filtration
Use: Gram Negative Aerobes, Bacterial Endocarditis with B-lactam
Adverse effects: ototox, nephrotox, acute mm paralysis (do not give to pt with MG)
Bacterial pneumonias
Pathogenesis: aspiration, inhalation, hematogenous spread
Pneumococcal pneumonia
Risk factors:
- Age: children and elders
- Immunocompromised: decreased Ab (MM/aGG) or absence of spleen (function-SSA)
- Diminished local immunity: COPD, Cigarrettes, Alcohol, Drugs, CHF (pulm edema), prior influenza

R to penicillin, 1/2 cephs, TC, sulfa, macrolides, and increasing R to quinolones

Tx: Ceftriazone (3rd gen), if R - then vanco

Other causes: GAS, CA-MRSA, Hemophilus influenza, normal mouth bacteria --> Aspiration Pneumonia
Hospital Acquired Pneumonia
HA-MRSA, Kelbsiella pneumonia, Pseudomonas

Can be associated with ventilator use
Group A Strep Pharyngitis
Epidemiology: role of crowding, high attack rates
Tx: Penicillin V oral x 10 days or Benzathine Penicillin G IM once

Consequences:
- Suppurative: peritonsilar abscess, lymphadentisi
- Non-suppurative (toxin- or immune- mediated): Scarlet Fever, Rheumatoid Fever, Glomerulonephritis

Prophylaxis for pt with previous RF

Other causes: C. diphtheria (developing countries), viruses...
Common cold
Primarily caused by Rhinovirus, but also adenovirus, coronavirus, parainfluenza, influenza

Tx Sx: decongestants and acetaminophen
Otitis Media
Caused by normal respiratory flora
Tx: Decongestants, Ab, may require tubes to equalize pressure
Epiglottis
Rare but lethal
GAS and Pneumococcus
Signs: toxic, cyanosis, drooling, tachypnic, stridor

Tx: Secure airway, give Ab
Sinusitis
Primarily mechanical issue
viral URI - initiates mechanical blockage

Tx: decongestion and drainage, Ab less important
Croup/Laryngitis
Croup - kids, subglottis (barking cough)

Laryngitis - adults, true cords swollen
Impetigo
Vesicular, crusted superficial infection to the skin
usually in children, spread in families, daycares, friends

Usually GAS, also SA
Sequellae: Glomerulonephritis

Looks awful but kid isn't sick at all (superficial)

Tx: Ab ointment
Cellulitis
Spreading infection in the dermis

GAS, other B-hemolytic Strep, SA
Often causes bacteremia

4 cardinal signs of inflammation with lymphangitis streaking up from rash

Blood culture

Tx IV Ab
Boil
Small abscess in dermis and subQ tissue - pt not ill

Usually SA

Tx Drain via incision or warm compress
Carbuncle
multilobulated abscess; often on neck where skin is thick
common in men, esp with DM

Usually SA

Can be bacteremic

Tx: IV ab, surgery
Abscess
walled-off collection of purulent material composed of bacteria and inflammatory cells (PMNs)

SA or mix
Can become bacteremic, can be within a structure

Blood culture
Necrotizing Fasciitis
Spreading infection of fascial tissue
Incredibly painful

GAS, GBS, or mix

Blood culture

Tx: surgery, antibiotics, antitoxin
- Clindamycin to stop protein synthesis + bacteriocidal drug
Myonecrosis
Spreading infection of muscle and fascial tissue

GAS, Clostridium species

Blood culture

Tx: surgery, antibiotics, antitoxin
- Clindamycin to stop protein synthesis + bacteriocidal drug
Toxic Shock Syndrome
toxin-mediated disease associated with local infection with Staph or Strep

SA, GAS

Tx: patient support (ie give fluids) and remove source, give Ab (secondary)

Prophylaxis with ENT use of tampon
Scalded Skin Syndrome
Pediatric - skin peeling

SA exfoliative toxin
Skin and Soft Tissue Infections
Strep: spreading infections (esp GAS)
Staph aureus: localized infection with purulence

Risk factors: DM, neuropathy, IVDU, burns, trauma, lymphedema, surgery
Osteomyelitis
Acute: 90% SA
Chronic: Coag Neg Staph
Others: GAS, GBS, Gram Neg Bacilli, Fungi, TB

Risk factors: DM, SSA (microinfarcts)

Pathogenesis: trauma, hemotogenous spread, vascular insufficiency/neuropathy

Tx: -cidal Ab IV for 6 weeks; possibly longer in adults
Surgery if dead bone or remove prosthetic material
Septic Arthritis
SA (50-60%), N. gonorrhea (sexually active YA)
- GAS, GBS in children
- TB, fungi, mycoplasma

Risk factors: IVDU, chronic joint disease

Tx: -cidal Ab if possible; start with anti-SA and anti-gonorrhea drugs (Vanco + Ceftriaxone)

Prosthetic joint - Coag Neg Strep
- surgery to remove
Endocarditis
Staph, Strep, Enterococi
Pseudomonas in IVDU
Coag Neg Staph in prosthetic valves

Tx. Enterococci and Pseudomonas req 2 drug regimen
- B-lactam and Aminoglycoside
Need -cidal IV Ab 4 weeks

Prophylaxis for highest risk patients when undergoing procedures associated with bacteremic risk