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134 Cards in this Set
- Front
- Back
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What is the coverage of Aminoglycosides?
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Gram negative rods. Aerobic only.
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How many penicillin allergic patients are also allergic to Cephalosporins?
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5-10%
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if a pt with an infection has a history of post -op surgery, what bacteria is responsible
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staph aureus
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What are the side effects of Aminoglycosides?
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Nephrotoxicity and Ototoxicity.
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if a pt with an infection has a history of IV line, what bacteria is responsible
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staph epidermidis
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How many penicillin allergic patients are also allergic to Cephalosporins?
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5-10%
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if a pt with an infection has a history of implant, what bacteria is responsible
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staph epidermidis
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What is necessary to monitor when giving Aminoglycosides?
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Serum concentration = Peaks and troughs. Peaks are taken 30 min after the end of 30 min. IV infusion. Trouphs are taken 30 min before dose is infused.
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if a pt with an infection has a history of scratching, what bacteria is responsible
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tinea infection with secondary bacterial infection (gram neg)
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Are Cephalosporins effective against MRSA and enterococci?
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No
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if a pt with an infection has a history of puncture wound, what bacteria is responsible
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-cellulitis can be caused by staph and strep, or osteo can be caused by pseudomonas
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Which Aminoglycoside has good Pseudomonas and Serratia coverage?
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Gentamicin.
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if a pt with an infection has a history of IV drug use, what bacteria is responsible
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MRSA, MRSE, Pseudomonas
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What are the types of tinea pedis
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Moccasin type, which can be dermatophytosis simplex or dermatophytosis complex and also vesicular type
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if a pt with an infection has a history of water realted infection, what bacteria is responsible
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pseudomonas, aeromonas hydrophilia, vbrio vulnificans,mycobacterium marinum
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Which Aminoglycoside is used for organisms that are resistant to other aminoglycosides?
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Amikacin/Amikin
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if a pt with an infection has a history of dog/cat bites, what bacteria is responsible
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pasteurella multicida
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What gram negatives are 1st generation Cephalosporins effective against?
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Proteus mirabili, E. coli and Klebsiella pneumonia
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if a pt with an infection has a history of human bites, what bacteria is responsible
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eikenella corrodens
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What three infections are treated by Streptomycin?
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Tularemia, TB and Plague.
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what part of your body regulates body temperature
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hypothalamic regulatory center
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Are Cephalosporins effective against MRSA and enterococci?
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No
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what stimuli affect the hypothalamus to regulate temperature to cause a fever
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endogenous pyrogens secreted by leukocytes and Kupffer cells (also bacterial endotoxins, phagocytosis and certain immune rxns)
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What is considered the broadest spectrum antibiotic?
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Primaxin 250-1000 mg IV/IM q6-8 hours.
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What is the adult dosage for Cefadroxil/Duricef?
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1-2 g per day divided qd/bid.
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What is the Drug of choice in severe limb threatening diabetic infections?
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Primaxin 250-1000mg IV/IM q6-8 h.
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Name some Cephalosporins from each generation
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1st parenteral cefazolin (ancef, Kefzol)
1st oral cephalexin (keflex, keftab) , cefadroxil (duricef) 2nd generation - parenteral (cefoxitin (mefoxin) cefuroxime (zinacef), cefotetan (cefotan) 2nd generation - oral - cefaclor (ceclor) cefuroxime axetil (ceftin), cefprozil (cefzil) 3rd generation pareteral cefotaxime (claforan), ceftizoxime (cefizox) ceftriaxone (rocephin), ceftazidime (fortaz) cefoperazone (cefobid) 3rd generation - oral cefdinir (omnicef), fourth generatin - parenteral - cefepime (maxipime) |
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What is the only antibiotic that can be sed alone in a diabetic foot infection?
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Primaxin 250-1000mg IV/IM 16-8 hours.
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What is the adult dose for Cephalexin/Keflex?
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250-500 mg PO qid
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What is the most common antibiotic for surgical prophylaxis?
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Cefazolin/Ancef 0.5-2g IV q 6-8 hours.
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What gram negatives are 1st generation Cephalosporins effective against?
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Proteus mirabili, E. coli and Klebsiella pneumonia
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What is the best cephalosporin against Pseudomonas?
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Ceftazidime/Fortaz 1-2gIV q8-12 hours.
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What gram negative bacteria are 2nd generation cephalosporins effective against?
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H. flu, Enterobacter, Neisseria, Proteus, E. coli, and Klebsiella pneumonia
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What is the coverage of Chloramphenicol?
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Gram negatives including anaerobes.
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What 2nd generation cephalosporin is effective against bacteroides
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cefoxitin and ceftetan
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in times of infection, what vital signs will increase in value
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-temp, BP, pulse, respiratory rate, BG is diabetic
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What are the side effects of Chloramphenicol?
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Gray Baby Syndrome, Bone Marrow suppression (aplastic anemia).
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what are 4 signs of septic patient
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elevated temp, hypotensive, tachycardic, tachypnic (rapid breathing)
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T/F 3rd generation cephalosporins are not effective against pseudomonas.
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False. 3rd generation cephalosporins are effective against Gram negative organisms, including pseudomonas.
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what is the difference between septicemia and bacteremia
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bactermia means there is bacteria in the blood and it can spread to distant foci; septicemia in addition to bacteremia has F/C and represents the failure of the body to localize infection
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What is the coverage of Clindamycin/Cleocin?
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Anaerobes
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What is the adult dosage for Cefadroxil/Duricef?
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1-2 g per day divided qd/bid.
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what ABI is inadequate for healing in DM
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ABI less then 0.45
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What is the side affect of Clindamycin/Cleocin?
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Pseudomembranous colitis (Clostridium difficile) - treat with Vancomycin oral dose.
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how many mmHg is needed to heal a digital wound (blood flow)
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at least 30 mmHg
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T/F Ciprofloxacin is a fluoroquinolone with poor pseudomonas coverage.
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False - Ciprofloxacin has good pseudomonas coverage as well as good Gram negative coverage.
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What organisms are generally resistant to all cephalosporins?
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methicillin resitant organims, including S. aureus and Staphlococcus epidermidis, enterococci, clostridium difficile, acineobacter
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For what group of patients is ciprofloxacin contraindicated?
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Children - it causes cartilage degeneration.
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What is the adult dose for Cephalexin/Keflex?
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250-500 mg PO qid
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What combined with ciprofloxacin is good for diabetic foot infections?
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Clindamycin or Metronidazole
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examples of aminopenicillins and ha they're good against
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ampicillin and amoxicillin
good against streptococci, GRAM NEGATIVE ORGANISMS, NOT GOOD AGAINST MOST STAPHYLOCOCCI. |
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What other fluoroquinalone makes a good substitute for Ciprofloxacin?
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Levofloxacin/Levaquin.
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What gram negative bacteria are 2nd generation cephalosporins effective against?
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H. flu, Enterobacter, Neisseria, Proteus, E. coli, and Klebsiella pneumonia
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when should size of a wound be measured (before or after debridement)
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after debridement
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What is the oral adult dosage for Levaquin?
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500-750 po qd
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what are the diff kinds of bases you can have in a wound
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granular, fibrotic, fatty, necrotic, mascerated
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First choice and alternate drug for methicillin sensitive staph?
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1st: oral: a cephaloasporion like cephalexin, IV cefazolin
Alt: oral: clindamycin, Azithromycin, penicillin eg. Dicloxacillin,IV nafcillin, |
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What is a Z-pack?
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Azithromycin 500 mg po first day, then 250 mg po qd x 4 days.
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T/F 3rd generation cephalosporins are not effective against pseudomonas.
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False. 3rd generation cephalosporins are effective against Gram negative organisms, including pseudomonas.
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Wagner Grade 0
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no open lesions may have keratosis or cellulitis
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What is the single-dose treatment for Chlamydia?
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Azithromycin/Zithromax 1000 PO single dose.
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Wagner Grade 1
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superficial ulcer, doest go beyond skin
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First choice and alternate drugs for Streptococcus?
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1st:
oral: cephalosporin like cephalexin IV: cefazolin. |
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Wagner Grade 2
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beyond full thickness of skin, Ulcer extends to ligament, tendon, joint capsule or deep fascia without abscess/osteomyelitis
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What antibiotic with good Gram positive coverage is used with Penicillin allergic patients?
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Erythomycin
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Wagner Grade 3
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ulceration to bone, Deep ulcer with abscess, osteomyelitis or joint sepsis
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T/F Ciprofloxacin is a fluoroquinolone with poor pseudomonas coverage.
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False - Ciprofloxacin has good pseudomonas coverage as well as good Gram negative coverage.
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Wagner Grade 4
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wet or dry Gangrene localized to forefoot or heel (may or may not have cellultis)
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What class of antibiotic is Aztreonam?
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A Monobactam
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Wagner Grade 5
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extensive gangrene to portion of the foot or whole foot, foot salvage is not possible
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e coli /proteus
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1st cephalosporin like cephalexin (oral), cefazaolin IV
alternate: quinolone |
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What is Aztreonam's coverage?
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Gram negatives and Pseudomonas.
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what does a fruity wound odor suggest
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pseudomonas
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For what group of patients is ciprofloxacin contraindicated?
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Children - it causes cartilage degeneration.
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what does a foul odor indicate
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anerobes
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What bacteria are 1st generation Penicillins mainly used for?
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Streptococcus
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abnormal redness of the skin due to capillary congestion such as inflammation
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erythema
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What combined with ciprofloxacin is good for diabetic foot infections?
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Clindamycin or Metronidazole
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acute spreading infection of the skin and CT
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cellulitis
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What is the oral form of Penicillin G?
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Penicillin V/Pen-Vee K
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how do cellulitis and erythema differ
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cellulitis is more wide spread and its boundaries are NOT clearly demarcated
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What other fluoroquinalone makes a good substitute for Ciprofloxacin?
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Levofloxacin/Levaquin.
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What penicillin is used for pre-op prophylaxis against endocarditis?
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Amoxicillin/Amoxil
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What is the oral adult dosage for Levaquin?
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500-750 po qd
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What class of Penicillins are the "Anti-Pseudomonal" penicillins?
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4th generation penicillins including Carbenicillin 376 mg PO qid.
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What is a Z-pack?
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Azithromycin 500 mg po first day, then 250 mg po qd x 4 days.
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What is the mechanism of action of the Sulfonamides?
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They compete for the dihydropteroate synthetase enzyme in the folic acid metabolic cycle of bacteria.
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lymphangitis
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blood poisoning, red streaks up the legs along the lymphatic channels from infection into the blood
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What is the single-dose treatment for Chlamydia?
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Azithromycin/Zithromax 1000 PO single dose.
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what is the #1 cause of lymphangitis
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Group A Strept
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Tetracycline antibiotics are the drug of choice for which infections?
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Rickettsia, M. pneumoniae, and chlamydia.
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What antibiotic with good Gram positive coverage is used with Penicillin allergic patients?
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Erythomycin
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For which patients are Tetracyclines contraindicated?
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Pregnant women, infants and children up to 8 years old due to permanent staining of teeth.
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What class of antibiotic is Aztreonam?
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A Monobactam
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Tetracycline 500 mg po qid is used for whch infections?
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Lyme's disease, Rocky Mountain Spotted Fever and H. pylori.
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Periosteal reaction
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callus formation or formation of new bone in response to injury; white fuzziness out of line of the normal coritcal bone line
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What is Aztreonam's coverage?
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Gram negatives and Pseudomonas.
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lytic lesion with sclerotic border
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dark hole in the bone with a white sclerotic border (seen in osteo)
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What is the drug of choice for Lebrosy?
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Dapsone 50-100 mg PO qd
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sequestrum
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piece of dead bone that becomes seperated from healthy bone during necrosis (detached necrotic cortical bone)
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What bacteria are 1st generation Penicillins mainly used for?
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Streptococcus
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involucrum
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new layer of bone growth outside existing bone, results from the stripping of the periosteum by build up of pus in the bone and new bone growing from the periosteum
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Metronidazole/Flagy has good coverage for what type of bacteria?
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Anaerobes
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cloaca
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space in which the dead bone resides
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What is the oral form of Penicillin G?
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Penicillin V/Pen-Vee K
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For which patients is Metronidazole/Flagyl contraindicated?
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Pregnant women due to teratogenic potential.
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What penicillin is used for pre-op prophylaxis against endocarditis?
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Amoxicillin/Amoxil
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What is the drug of choice for VRE?
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Linezolid 400-600mg PO bid.
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What class of Penicillins are the "Anti-Pseudomonal" penicillins?
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4th generation penicillins including Carbenicillin 376 mg PO qid.
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what first line tests would you order for a pt with infection upon inital presentation
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CBC with diff, Chem Panel
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Vancomycin is only dosed orally for what infection?
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500mg po qid for pseudomembranous colitis.
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what is included in a Chem panel
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BUN, Creatine, Glucose, electrolytes (Na,K, Cl, CO2)
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What is the mechanism of action of the Sulfonamides?
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They compete for the dihydropteroate synthetase enzyme in the folic acid metabolic cycle of bacteria.
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Tetracycline antibiotics are the drug of choice for which infections?
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Rickettsia, M. pneumoniae, and chlamydia.
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For which patients are Tetracyclines contraindicated?
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Pregnant women, infants and children up to 8 years old due to permanent staining of teeth.
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Tetracycline 500 mg po qid is used for whch infections?
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Lyme's disease, Rocky Mountain Spotted Fever and H. pylori.
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What is the drug of choice for Lebrosy?
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Dapsone 50-100 mg PO qd
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Metronidazole/Flagy has good coverage for what type of bacteria?
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Anaerobes
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For which patients is Metronidazole/Flagyl contraindicated?
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Pregnant women due to teratogenic potential.
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What is the drug of choice for VRE?
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Linezolid 400-600mg PO bid.
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Vancomycin is only dosed orally for what infection?
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500mg po qid for pseudomembranous colitis.
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if a pt has leukocytes and nitrates in the urine
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probably UTI
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what are 3 classifications of osteomyelitis (Waldvogel)
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hematogenous, contiguous, vascualr impairment, chronic osteomyelitis
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hematogenous osteomyelitis
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usually staph aureus or strep in neonates
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contiguous osteomyelitis
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direct infection bone from exogenous source or spread of infection from a near by infected focus (prosthesis, implants, open fx)
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Clerny-Mader classifies osteomyelitis based on anatomic and physiologic stage; what are the anatomic stages
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medullary, superficial, localized and diffuse
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Clerny-Mader classifies osteomyelitis based on anatomic and physiologic stage; what are the physiologic stages; these are the factors that may compromise their healing
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A: Normal Host
BS: Systemically compromised Host BL: locally compromised host C: tx is worse then the disease |
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synovial fluid glucose concentration is normally slightly less then that of blood glucose, what glucose level suggests joint infection
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a very low level of gluose in the synovial fluid
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what factors contribute to the increasing incidence and risk of TB
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supression of the immune system, dvlpment of drug resistant strains of mycobacterium, aging population, inc # of healthcare workers who are exposed
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what pre-exisitng disease has the leading risk for reactivation of laten TB infection
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HIV
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which organism is responsible for TB infections in the US
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Mycobacterium tuberculosis
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what is Pott's disease
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TB of the vertebra
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what are the steps of tx for TB
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1. pt is isolated
2. contact CDC and infection specialist 3. minimum of 3 antibiotics, one of which should be bactericidal 4. tx for 6-9 mths if only pulmonary involvement, tx for 12-18 mths if extrapulmonary TB |
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what are some possible antibiotic choices for TB and their doses
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Isoniazid (3-5 mg/kg/day)
Pyridoxine (10 mg QD) Rifampin (10mg/kg/day) Pyrazinamide (20-25 mg/kg/day) Ethambutol (15-25 mg/kg/day) Streptomycin (15-20 mg/kg/day) |
