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50 Cards in this Set
- Front
- Back
Penicillins
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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) |
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Penicillin G
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Narrow spectrum (G+)
B-lactamase sensitive Pareneteral Streptococcal |
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Penicillin V
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Narrow spectrum (G+)
B-lactamase sensitive Oral Streptococcal |
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Methicillin
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Narrow spectrum (G+)
B-lactamase resistant Parenteral Staph aureus |
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Nafcillin
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Narrow spectrum (G+)
B-lactamase resistant Parenteral Staph aureus *not excreted renally |
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Oxacillin, cloxacillin, dicloxacillin
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Narrow spectrum (G+)
B-lactamase resistant Oral Staph aureus *Oxacillin not excreted renally |
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Ampicillin, Amoxicillin
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Extended spectrum (G+, some G-)
B-lactamase sensitive Oral E. coli |
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Ticarcillin
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Extended spectrum (G+, some G-)
B-lactamase sensitive Parenteral Pseudomonas aeruginosa |
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Mezlocillin
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Extended spectrum (G+, some G-)
B-lactamase sensitive Parenteral Pseudomonas aeruginosa |
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Piperacillin
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Extended spectrum (G+, some G-)
B-lactamase sensitive Parenteral Pseudomonas aeruginosa |
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Benzathine or Procaine Penicillin G
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Delayed absorption penicillins
Clinical use: streptococcal pharyngitis, Syphilis Narrow spectrum (G+) B-lactamase sensitive Parenteral |
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Augmentin
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Amoxicillin + Clauvulanic Acid
Tx: Otitis media, Sinusitis - Staph aureus |
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Timentin
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Ticarcillin + Clauvulanic Acid
Tx. Staph aureus, bacteriodes |
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Unasyn
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Ampicillin + Sulbactam
Tx. Staph auerus, E. coli |
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Zosyn
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Piperacillin + Taxobactam
Tx. Complicated skin infections, intraabdominal infections |
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Cephalosporins
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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 |
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1st Generation Cephalosporin
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G+ >> G-
Oral Clinical use: Staph, Strep, E. coli |
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2nd Generation Cephalosporin
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G+ ~ G-
Oral Clinical Use: E. coli, Klebsiella, Proteus |
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3rd Generation Cephalosporin
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G- > G+
More resistant to B-lactamases Clinical uses: Strep pneumonaie, N. gonorrhea, N. meningitides, Pseudomonas aeruginosa |
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Cefepime
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4th Generation Cephalosporin
Increased stability against B-lactamases G+ and G- Tx: Pseudomonas aeruginosa, Neutropenic fever |
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Ceftaroline
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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 |
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Cefotetan
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Methylthiotetrazole Ring
can cause bleeding disorders by interfering with vitamin K dependent clotting Disulfram-like action: interfering with alcohol metabolism |
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Aztreonam
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Cephalosporin (own class) - "mono bactam"
Very narrow spectrum: G- aerobes only Resistant to B-lactamases Non-nephrotoxic, non-ototoxic alternative to aminoglycosides |
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Diphtheria Toxin
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Only lysogenized Corynebacteria
ADP-ribosylates EF2 inhibiting protein synthesis and kills host cell DtxR: repressor, must be bound to Fe |
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Carbapenems
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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) |
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Vancomycin
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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) |
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Daptomycin
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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 |
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Aminoglycosides
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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) |
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Bacterial pneumonias
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Pathogenesis: aspiration, inhalation, hematogenous spread
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Pneumococcal pneumonia
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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 |
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Hospital Acquired Pneumonia
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HA-MRSA, Kelbsiella pneumonia, Pseudomonas
Can be associated with ventilator use |
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Group A Strep Pharyngitis
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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... |
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Common cold
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Primarily caused by Rhinovirus, but also adenovirus, coronavirus, parainfluenza, influenza
Tx Sx: decongestants and acetaminophen |
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Otitis Media
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Caused by normal respiratory flora
Tx: Decongestants, Ab, may require tubes to equalize pressure |
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Epiglottis
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Rare but lethal
GAS and Pneumococcus Signs: toxic, cyanosis, drooling, tachypnic, stridor Tx: Secure airway, give Ab |
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Sinusitis
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Primarily mechanical issue
viral URI - initiates mechanical blockage Tx: decongestion and drainage, Ab less important |
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Croup/Laryngitis
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Croup - kids, subglottis (barking cough)
Laryngitis - adults, true cords swollen |
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Impetigo
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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 |
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Cellulitis
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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 |
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Boil
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Small abscess in dermis and subQ tissue - pt not ill
Usually SA Tx Drain via incision or warm compress |
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Carbuncle
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multilobulated abscess; often on neck where skin is thick
common in men, esp with DM Usually SA Can be bacteremic Tx: IV ab, surgery |
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Abscess
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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 |
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Necrotizing Fasciitis
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Spreading infection of fascial tissue
Incredibly painful GAS, GBS, or mix Blood culture Tx: surgery, antibiotics, antitoxin - Clindamycin to stop protein synthesis + bacteriocidal drug |
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Myonecrosis
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Spreading infection of muscle and fascial tissue
GAS, Clostridium species Blood culture Tx: surgery, antibiotics, antitoxin - Clindamycin to stop protein synthesis + bacteriocidal drug |
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Toxic Shock Syndrome
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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 |
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Scalded Skin Syndrome
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Pediatric - skin peeling
SA exfoliative toxin |
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Skin and Soft Tissue Infections
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Strep: spreading infections (esp GAS)
Staph aureus: localized infection with purulence Risk factors: DM, neuropathy, IVDU, burns, trauma, lymphedema, surgery |
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Osteomyelitis
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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 |
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Septic Arthritis
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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 |
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Endocarditis
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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 |