Infectious Disease Tst2 Set2

Front 1

Quinolones/Fluoroquinolones
a)MOA
b)1 structural thing

Back 1

a)bactericidal that inhibit DNA gyrase (topo2) and inhibit topo4 (supercoiling DNA enzymes)

b1)fluoridation @ C6 = incr antibacterial effects

Front 2

3 Gen's of Quinolones

Back 2

Gen1- non-fluorinated

Gen2- Cipro (mostly active against G-)

Gen3- Levo/Moxifloxacin (incr activity against G+ and G-'s)

Front 3

Short/Long acting fluoroquinolones

Back 3

Short is Cipro

Long is Moxifloxacin (is well GI absorbed and ONLY FQ eliminated hepatically--rest are renal elimination = all other FQ's need dosage adjust in renal dysfxn)

Front 4

ONLY oral drug good against Pseudomonas?

Back 4

Cipro

Front 5

Quinolones ADR's (5)

Back 5

1)GI symptoms
2)CNS (excitation/seizure)
3)cartilage damage/tendonitis (so no under 18yo)****
4)prolong QRS interval if on antiarrhythmics
5)interact w/ antacids

Front 6

Quinolones major indications (6)

Back 6

1)complicated UTI's
2)bacterial prostatitis
3)chronic osteomyeltitis (b/c the quinolones get into bone)
4)bacterial diarrhea
5)bacterial pneumonia in CF pts (use CIPRO)
6)community acquired pneumonia (3rd gen's only)

Front 7

Sulfonamides, Sulfones, Aminosalicylic acid MOA (4)

Back 7

1)structural anaglogs of PABA, building block of folate synthesis
2)sulfonamides have affinity for bacterial DHP synthesis enzymes
3)sulfones (leprosy) and aminosalicylic acid (anti-tubercular) are good for the corresponding enzyme in Mycobacteria
4)folate is reqd in bacteria for thymidine syn (and therefore DNA syn)

Front 8

TMP
a)MOA

Back 8

inihbits folate reductase

Front 9

Sulfonamides spectrum (3)

Back 9

1)broad, bacteriostatic
2)good against G+/G-
3)also good against actinomycetes, nocardia, chlamydia

Front 10

PK of Sulfonamides (5)

Back 10

1)highly lipophilic
2)bind to plasma proteins
3)well distributed in body (incl CNS/fetus)
4)metabolized in liver by acetylation, glucuronidation, oxidation
5)excreted in urine

Front 11

ADR of Sulfonamides (3)

Back 11

1)crystalluria
2)hypersensitivity rxn (common)
3)Kernicterus**** (safe in pregnancy but not in late 3rd trimester)

Front 12

1 Sulfonamides and what it is good for

Back 12

1)Sulfamethoxazole
2)UTIs!!!!

Front 13

Sulfonamide Combo's
a)drug
b)proprties (2)
c)excretion

Back 13

a)TMP/SMX (Bactrim)

b1)Synergistic combo of drugs
b2)5:1 ratio of SMX:TMP

c)both are excreted primarily in urine

Front 14

Bactrim where used (5)

Back 14

1)UTIs!!!
2)OM
3)bronchitis
4)bacterial diarrhea
5)drug of choice for P. carinii pneumonia (protozoal)

Front 15

Long acting sulfonamide combo and use

Back 15

Sulfadoxine and Pyrimethamine (another folater reductase inhibitor)

once-weekly tx of malaria that is resistant to other drugs

Front 16

Daptomycin
a)MOA
b)use (2)

Back 16

a)CYCLIC LIPOPEPTIDE; detergent like axn on bacterial membranes; destroying the barrier fxn and killing the cells

b)G+ mostly
b)complicated skin infexns caused by Staphylococci including MRSA

Front 17

Methenamine
a)MOA (3)

Back 17

a1)in acid (like urine) it dissociates into formaldehyde
a2)bacteria are killed by liberated formaldehyde and RESISTANCE DOES NOT DEVELOP
a3)must be formualted w/ urine acidifier (hippuric, mandelic)

Front 18

Nitrofurantoin
a)spectrum
b)ADR's

Back 18

a)bacteriostatic good against G+ and G-'s that cause UTI

b)GI!!! (minimized in macrocrystalline prep)

Front 19

Fosfomycin Tromethamine use/MOA (3)

Back 19

1)single dose often effective
2)good for UTI
3)inhibits pyruvyl transferase

Front 20

Metronidazole
a)use (3)
b)ADRs (4)

Back 20

a1)antiamebic activity
a2)tx trichomoniasis, amebiasis, giardiasis
a3)also good against obligate anaerobes (BACTEROIDES)

b1)GI
b2)dizziness
b3)alcohol intolerance
b4)risk of neurotoxic effects and risk of carcinogencity

Front 21

2 PO abx that are good against anaerobes

Back 21

Clindamycin

Metronidazole

Front 22

Clarithromycin and H. flu

Back 22

has 14-OH metabolite that is good against H. flu

Front 23

4 drugs that are alternatives to Vanco to fight VRSA (4)

Back 23

1)Quin-Dalfo
2)Linezolid
3)Tigecycline
4)Daptomycin

Front 24

Respiratory infexn bugs (4) and preferred drugs (3)

Back 24

a1)S. aureus
a2)S. pneumonia
a3)H. flu
a4)M. catarrhalis

b1)Amox/Clav
b2)Bactrim
b3)3rd Gen Cephalosporins

Front 25

Patient Interview look for what when determining if there is an infexn (4)

Back 25

1)sick contacts (kids in daycare, Tb case)
2)unusual pets
3)exposures (occupation, recreational)
4)recent travel (developing countries, endemic infectious pathogens)

Front 26

Vital signs/Physical exam look for what in determining if there is an infexn (4)

Back 26

1)fever (over 100.4 BUT absence does NOT exclude an infexn)
2)CV (murmur)
3)Respiratory (tachypnea/rales)
4)skin (rash, erythema, edema)

Front 27

LOCALIZED s/sx when looking for an infexn in:
a)CELLULITIS (skin infexn) (3)
b)PNEUMONIA (3)
c)PYELONEPHRITIS (kidney infexn) (2)

Back 27

a1)skin warmth
a2)erythema
a3)tenderness

b1)cough
b2)sputum
b3)breathing difficulties

c1)flank pain
c2)dysuria

Front 28

SYSTEMIC s/sx in infexn (3 w/ 2,2,3)

Back 28

Hemodynamic Instability
a)vasodilation/hypotension
b)organ hypoperfusion/dysfxn

Acid/Base Changes
a)lactic acidosis
b)respiratory alkalosis due to tachypnea

Neurologic Manifestations
a)lethargy/confusion
b)agitation/anxiety
c)psychosis

Front 29

Predisposing Immunosuppression factors to infexn (2)

Back 29

a)disease states (DM,HIV)
b)drugs (chemo, biologics)

Front 30

WBC count w/ differential and infexn (4)

Back 30

1)often incr in infexn
2)"left shift" (incr in bands) = infexn
3)WBC may be normal or decr in immunocompromised ppl (HIV/chemo)
4)in severe sepsis WBCs may be incr or decr

Front 31

Other lab data to get when trying to determine if there is an infexn (3)

Back 31

1)chemistry panel (electrolytes, BUN/SCr, glc)
2)LFTs
3)ABGs

Front 32

Culture data and infexn

Back 32

obtaining cultures prior to abx therapy initiation is ideal*****

Front 33

When to use prophylaxis therapy (2)

Back 33

1)PRIMARY: prevention of 1st infexn in susceptible populations (surgery)
2)SECONDARY: prevention of subsequent infexn (recurrent UTI)

Front 34

When to use Empiric abx therapy (2)

Back 34

1)treatable infexn suscepted but unproven
2)treatment is based on most likely MO and susceptibilities

Front 35

When to use specific/definitive therapy for an infexn (2)

Back 35

1)treatment of proven infexn
2)usually w/ organism identification and abx susceptibilities avaliable

Front 36

SOME Factors to consider when deciding which abx should be selected (4 w/ 0,0,0,2)

Back 36

1)likely MOs
2)susceptibilities (want narrowest spectrum possible)
3)site of infexn/abx penetration (bone, CNS, etc)

4)hospital or community acquired?
a)inpt or outpt tx? (iv or po?)
b)local suspectibilites/antibiogram helpful

Front 37

Host Factors when determining which abx to use (3)

Back 37

1)drug allergy
2)age
3)pregnancy and breast feeding

Front 38

Organ Fxn and antibiotic choice (2 w/ 0,5)

Back 38

1)dose adjustment may be needed for hepatic/renal dysfxn

2)Renal adjustment drugs*****
a)B-lactams (cept Ceftriaxone)
b)FQ's (cept Moxifloxacin)
c)AG's
d)Vanco
e)Bactrim

Front 39

OTHER factors to consider when deciding which abx should be used (3)

Back 39

1)drug interaction w/ concomitant meds
2)concomitant disease states
3)risk factors for specific infexns (immunosuppression)

Front 40

Bactericidal Abx
a)which classes are (4)
b)this is important in what diseases (4)

Back 40

a1)B-lactams
a2)vanco
a3)AG's
a4)FQ's

b1)endocarditis
b2)meningitis
b3)osteomyelitis
b4)neutropenia

Front 41

Bacteriostatic Abx
a)which classes are (5)
b)important b/c (2)

Back 41

a1)clindamycin
a2)macrolides
a3)TCN
a4)linezolid
a5)Bactrim

b1)good for immunocompetent pts
b2)more appropriate w/ bacteria that have toxins so the toxins are lysed into the body

Front 42

Concentration-dependent killing (3) vs. Concentration independent killing (time-dependent) (3)

Back 42

a1)rate/extent of bacterial killing incr w/ incr abx [] above MIC
a2)AG's/FQ's
a3)efficacy parameters: MIC ratio, AUC:MIC ratio

b1)extent of bacterial killing dependent on time of drug exposure
b2)B-lactams, Vanco
b3)efficacy parameter: time above MIC

Front 43

Implications of dosing w/
a)[] dependent abx (1)
b)[] independent abx (2)

Back 43

a1)HIGH-dose intermittent therapy

b1)multiple daily doses OR
b2)cont infusion (lower dose)

Front 44

Therapeutic [] monitoring is done w/ what drugs? (4)

Back 44

a)amikacin
b)gentamicin
c)tobramycin
d)SOMETIMES vancomycin

Front 45

What to consider in cost of abx therapy (4)

Back 45

1)brand v. generic
2)IV v. PO
3)frequency of administration
4)lab monitoring (CBC, chemistry, monitoring)

Front 46

Which dose and regimen should be used? Consider.... (5)

Back 46

1)organism
2)site of infexn
3)age
4)organ fxn
5)route of elimination

Front 47

Determining which route of admin is best (5)

Back 47

1)site/severity of infexn
2)pt ability to take oral meds
3)medication oral bioavailability
4)in or outpt (po preferred in both cases)
5)other ROA: intrathecal/intraventricular

Front 48

When to consider Home IV therapy for a pt (3)

Back 48

1)option for stable infexns requiring prolonged IV tx

b1)osteomyeltits
b2)prosthetic joint infexns
b3)endocarditis

Front 49

Appropriate duration of therapy (3)

Back 49

1)optimal duration of therapy is established for SOME infexns
2)MUST also follow pt's clinical response to therapy
3)minimizing antibiotic therapy duration/spectrum reduces colonization w/ resistant organisms

Front 50

Advantages of Combo Abx therapy (6)

Back 50

1)w/ mixed infexns (multiple likely organisms)
2)nosocomial infexns
3)severly immunocompromised pts
4)penicillin/AG's for entrococcal endocarditis (synergy)
5)Bactrim (synergy)
6)combo therapy efficacy is proven in some bugs to PREVENT resistance (Tb, H.pylori)

Front 51

Disadvantages of Combo Abx (4)

Back 51

1)additive drug toxicity
2)incr risk of colonization w/ resistant organisms (collateral damage)
3)drug inactivation/antagonism
4)incr cost

Front 52

Significance of Resistance (2)

Back 52

1)antimicrobial tx failure
2)incr morbidity/mortality/costs

Front 53

Contributing Factors to Resistance (3)

Back 53

1)overuse of abx in hospitals, community, agriculture
2)use of antimicrobial prophylaxis in immunosuppressed pts
3)50% of abx use in hospitals is inappropriate

Front 54

Prevention and control of Resistance (3 w/ 2,0,0)

Back 54

1)judicious use of antimicrobials thru
a)prescriber education
b)antibiotic stewardship/management programs

2)infexn control measures to limit the spread of resistant MOs (handwash/gloves)
3)development of new abx

Front 55

Monitoring Clinical Improvement of pt on abx (4)

Back 55

1)monitor same parameters used to diagnose infexn
2)clinical s/sx
3)diagnostic studies (radiological improvement lags behind clinical improvement)
4)if no clinical response in 2-3d explore reasons for tx failure

Front 56

DRUG SELECTION causes of antimicrobial failure (5)

Back 56

1)inappropriate spectrum
2)inappropriate ROA (malabsorption)
3)subtherapeutic dosing
4)drug interaxns
5)poor penetration into site of infexn

Front 57

Host Factors/MO factors in antimicrobial tx failure (3)

Back 57

1)immunosuppression= inadequate host defenses to augment antimicrobial effects
2)need for surgical intervention (incision and debridement/drainage)
3)MO resistance

Front 58

Monitoring Drug toxicity of abx (3)

Back 58

1)ADR
2)changing hepatic/renal fxn
3)manageable vs. requiring therapy modification

Front 59

When to consider IV to PO switch w/ abx (4)

Back 59

1)afebrile for 24-48hrs
2)decr WBC count
3)functioning GI tract
4)Abx w/ good oral bioavailability

Front 60

Abx w/ good oral bioavailability (6)

Back 60

1)FQ's
2)clindamycin
3)doxycycline
4)linezolid
5)metronidazole
6)bactrim

Front 61

How to intensify Abx therapy in treatment failure or non-response (3)

Back 61

1)broaden MO spectrum
2)add or switch to an abx w/ different MOA
3)re-eval potential causes for tx failure

Front 62

SAFE abx in pregnancy (4)

Back 62

1)pencillins
2)cephalosporins
3)macrolides
4)clindamycin

Front 63

AVOID abx in pregnancy (4)

Back 63

1)metronidazole (1st trimester)
2)Bactrim (1 and 3rd trimsters)
3)TCN's
4)FQ's