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155 Cards in this Set
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Main s/e of sulfonamides? (sulfa allergy)
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rashes
minor: crystalluria with high doses hemolytic anemia, leukopenia, thrombocytopenia |
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How are penicillins and sulfonamides different?
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Lots of things
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Penicillin G vs Penicillin V
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Penicillin G is given IV, hydrolyzed by acid, strep pneumo and spirochetes (Lyme, syphillis). Also, actinomycosis, anthrax, tetanus, botulism, diptheria, listeriosis, n. meningitidis (not gonorrhea), syphillis.
Penicillin V can be given orally, acid-stable, can be used for strep pharyngitis caused by Group A beta-hemolytic strep |
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How does penicillin work?
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Penicillin enters thru porin and binds to Penicillin binding protein which is a transpeptidase that links peptidoglycans.
Disrupts the balance between PBPs and autolysins, causing more autolysis to occur. |
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What does aztreonam treat?
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aerobic, gram negative rods.
Pseudomonas, klebsiella, and serratia |
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How can you extend the half life of penicillin?
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probenecid for penicillin.
inhibits organic acid anion pump for excretion of penicillin |
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What works against MRSA?
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Vancomycin
Linezolid daptomycin Tigecycline |
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What do you give cilastatin with?
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Imipenam (carbepenam)- hyrolyzed by renal proximal tubule dihydropeptidase; cilastatin is a competitive inhibitor of this
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What is the dangerous side effect of penicillin?
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Immediate (type I) hypersensitivity reaction (very rare)
quick and severe anaphylaxis Tx with epinephrine shot Delayed (type II) hypersensitivity by IgG or IgM; penicillin binds to tissues and then is bound by antibodies interstitial nephritis, hemolysis, rashes Delayed (type III) hypersensitivity) penicillin bound by antibody before it binds to tissues serum sickness, joint and muscle pains |
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What drug can be used as a diuretic in SIADH?
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demeclocycline (a tetracyline)
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What is the Amp-Gent combo?
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Ampicillin and gentamicin for broad gram negative coverage
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Penicillinase vs. B-lactamase?
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Penicillinase is secreted by gram positives (therefore you can use penicillinase resistant antibiotics such as nafcillin (naf for staph) bc its a gram positive that usu secretes penicillinase
B-lactamase-in the cell walls of gram negatives |
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what cephalosporin has excellent CSF penetration and is used for meningitis?
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ceftriaxone
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cephalosporins excretion and side effects
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very similar to penicillin
use the same organic anion transporter which can be blocked by probenecid hypersensitivity reaction |
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what are carbepenams good for and not good for?
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Everything except...
MRSA some Pseudomonas species (non-aeruginosa) Enterrococci mycoplasma |
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is resistance to carbepenams common?
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not very much resistance since it is the trans-configuration of the b-lactam ring, which makes it a difficult subtrate for b-lactamases
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What can tigecycline be used for
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MRSA and VRE (Vancomycin-resistant enterococcus)
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Fungal infection and don't know what it is. severely ill and neutropenic.
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Echinocandins
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what is the prototype carbapenam?
what are the side effects? what do you need to give it with and why? special considerations |
imipenam
seizures cilastatin (comp inhibitor of dihydropeptidase) b/c it is cleared by renal dihydropeptidase making it inactive and NEPHROTOXIC must be given IV bc it is hydrolyzed by acid |
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What carbapenams are NOT hydrolyzed by renal dihydropeptidase?
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meropenem, ertapenem
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excretion of carbapenems
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similar to penicillin, by renal organic anion transporter
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Side effects of carbepenems
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hypersensitivity cross sensitivity with penicillins
SEIZURES |
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how does aztreonam (monobactam) work?
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binding to PBP-3 which is present only in gram negative, aerobic rods
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how should you give aztreonam (monobactam)
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IV, due to its short half-life and susceptibility to stomach acid
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What makes aztreonam a good drug to give?
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no cross-allegenicity, usu. nontoxic (GI upset), covers all gram negative aerobic rods
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what do you give aztreonam with and why?
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usually with vancomycin or clindamycin (to include coverage over gram positives)
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What 4 antibiotics have broad gram positive coverage?
How does each work? |
clindamycin
linezolid daptomycin vancomycin (glycopeptide)-surrounds the terminal D-alanine precursor to peptidoglycan, thus preventing cross-linking |
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What 3 drugs have broad aerobic gram negative coverage?
How does each work? |
aztreonam- binds to PBP3 of all gram negatives
aminoglycosides- quinolones- |
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When do you use oral dosing of vancomycin?
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usually never b/c absorption is very poor, so give IV
BUT good for C. dificile colitis |
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What is the distribution of vancomycin in the body?
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large molecular weight prevents good distrib.
urinary levels are high (must monitor levels) |
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what must be done when giving vancomycin
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calculate creatinine clearance for proper dosing.
must monitor vancomycin levels in all patients |
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side effects of vancomycin
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red man syndrome-due to histamine release
deafness renal failure |
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what is ceftriaxone good for?
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3rd gen.
gonorrhea, and meningitis (Best CSF presentation) |
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If a pt gets a MRSA (gram +) infection of the elbow, what should you give?
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Vancomycin
Daptomycin, Linezolid Tigecycline |
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If pt. has N. gonorrhea (gram -), what is antibiotic of choice?
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Ceftriaxone
"Super" spectinomycin Quinolone (cipro, levofloxacin) |
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Describe image for vancomycin
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IV tubing- given IV, also good for infections caused by indwelling catheters
Colon; tx for c. dificile, pseudomembranous colitis Red man TONto: red man syndrome, thrombophlebitis, ototoxicity, Nephrotoxicity Driving Gram+ ambulance- broad gram + coverage into D-ala-d-ala peptidoglycan wall |
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How can you get resistance to fluoroquinolones?
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mutations in a or B subunits of DNA gyrase or decreased binding of quinolones
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venir
viens plus prés viens au lit Tu viens avec nous |
to come
Come closer Come to bed Are you coming with us |
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mech of action for aminoglycosides
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reversible binding to 30s
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What are some probs with aminoglycosides
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poor absorption with oral administration- good for decontamination of GI tract prior to surgery
big molecule, so does not get into tissues well like CSF....but good enough to treat pneumonia |
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What must you do prior to giving aminoglycosides
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measure GFR (creatinine clearance) to prevent toxicity
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what two drugs must you use to measure GFR (creatinine clearance) to prevent toxicity
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aminoglycosides (streptomycin, genatmicin)
glycopeptides (vancomycin) |
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side effects of aminoglycosides
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streptomycin, gentamicin, neomycin
8th CN damage, vertigo, irreversible hearing loss nephrotoxity complete neuromuscular blockade (reversible) |
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3 most common macrolides
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erythromycin, azithromycin, clarithromycin
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how do the macrolides work
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erythromycin, clarithromycin, azithromycin
all work by inhibition of the 23s rRNA portion of the 50s subunit |
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what are the macrolides good for?
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gram positives
URIs, pneumonias, STDs Legionella, mycoplasma, Chlamydia, Neisseria |
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side effects of macrolides
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GI upset (most common)
cholestatic hepatitis prolonged QT |
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what abt ketolides
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a macrolide with ketolide attached to it, much tighter binding
100%effective against strep pneumo s/e rare liver necrosis no longer used |
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name a lincosamide
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clindamycin
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what is clindamycin good for
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anaerobes
gram positive |
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how does clindamycin work
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50S
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distribution of chloramphenicol to tissues
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EXCELLENT, including CNS!
bc of lipophilic and hydrophilic props can be used to treat meningitis |
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how does chloramphenicol work
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binds to peptidyl transferase of the 50s subunit
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what does chloramphenicol treat?
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everything
use in meningitis or when children and pregnant women CANNOT take Tetracylcine, use chloramphenicol as alternative |
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Side effects of chloramphenicol
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conservative use of it due these side effects
Bone marrow depression (aplastic anemia)-irreversible, no treatment Gray baby syndrome |
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what should not be used against routine gram positive cocci infections (even though it would kill the bacteria)
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linezolid; should be saved for infections with VRE
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side effect of Amp B
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Shake and Bake (fever and chills)
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how does metronidazole work
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forms toxic metabolites
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what is metronidazole good for
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GET GAP on the Metro
Giardia, entamoeba histolytica (amebiasis), trichomonas vaginalis Gardnerella vaginalis, Anaerobes (b. fragilis, c. dificile), H. pylori |
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side effects of METROnidazole
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disulfaram like effect
metallic taste |
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how does daptomycin work?
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alters bacterial cell membrane, K+efflux
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What bacteria is famous for growing in mayonnaise resulting in food poisoning?
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Staph aureus
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what are the 3 exotoxins for anthrax?
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Lethal factor
Edema factor Protective Antigen |
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you see a black eschar on the skin. how do you determine if it is a spider bite vs. anthrax
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anthrax will have edematous swelling around the eschar due to edema toxin
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what two findings do you find on chest Xray in a person with pulmonary anthrax
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mediastinal widening
pleural effusions |
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how to determine betw inhalational anthrax vs URI?
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runny nose assoc with viruses and respiratory infections
inhalational anthrax does not have a runny nose |
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smallpox vs. chicken pox
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smallpox is a poxvirus, get sick first, then contagious later, affects dermis (scars) in one SYNCHRONOUS wave, affects face and arms more
chickenpox is a herpesvirus, contagious first, sick later, affects epidermis ASYNCHRONOUS, affects trunk more |
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tx of smallpox
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None
if early pre-exposure, give Vaccinia vaccine (from cowpox) |
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Side-effects of smallpox vaccine (vaccinia vaccine)
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erythema multiforme
auto-inoculation generalized vaccinia eczema vaccinatum- weird rxn to vaccine, become replication machines for vaccinia Progressive vaccinia in lymphoma |
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What are the most important clinical manifestations of tularemia?
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Ulceroglandular- cutaneous ulcers
Pneumonic-bronchopneumonia others: ocularglandular (conjunctivitis), oropharyngeal (exudative pharyngitis), and typhoidal (fevers, chills) |
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Tx for tularemia
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prophy: doxycycline
Tx above or strepto (same for plague) |
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Gram stain of tularemia
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Gram negative, coccobacillus
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What is the vector for tularemia
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tick, deerfly
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what is gram stain for anthrax?
how to remember |
Gram positive spore forming rod
Think Bacillus anthracis....and B cereus |
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plague, yersinia pestis gram stain
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gram negative coccobacillus
safety-pin appearance |
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how to transmit plague
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fleas from rats, prairie dogs (SW US)
spread via inhalation as well |
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Where are plague cases seen in the US?
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SW (from prairie dogs)
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clinical presentation of plague
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flea bite and bubos (swollen inguinal lymph nodes)
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vectors of plague (yersinia pestis)
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fleas
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tx for plague-yersinia pestis
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prophy: doxy
tx:above + strepto |
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presentation of pneumonic plague
transmission |
pneumonia with hemoptysis
highly fatal if untreated PERSON TO PERSON spread no person-person spread in tularemia, anthrax pneumonia |
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gram stain of clostridium botulinum
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gram positive, spore forming rod
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gram positive, spore forming rods found in soil
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b. cereus, b anthracis
c. botulinum, c. perfringens, c. tetani |
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Tx for botulism
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Antitoxin
Respiratory support |
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young person develops flu-like symptoms with pulmonary edema in the SW. what could he have?
tx? |
Hantavirus
Supportive care |
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Describe borrelia (spirochete) shape
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small, thin bacteria
corkscrew shape, flagella holds it together corkscrew thru tissue lots of lipoproteins (evades immune system) |
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what causes relapsing fevers?
how? vector? |
borrelia recurrentis
thru antigenic variation human body louse |
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2 high risk areas for lyme disease
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Wisconsin
Eastern US |
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what is different abt adult tick from other insects?
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8 legs
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what causes lyme dz? vector?
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borrelia burgdorferi transmitted by ixodes tick
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stages of lyme dz and symptoms
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Stage 1:ECM rash that spreads out
stage 2: ECM rashes, CNS (meningitis, Bell's palsy), HEART (cardiac dz), JOINTS (arthritis) stage 3: chronic arthritis, chronic fatigue from encephalitis |
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Tx of lyme dz
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doxycycline/tetratcycline
if severe, ceftriaxone |
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tx of relapsing fever
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since its caused by ixodes tick
give doxycycline or tetracycline |
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transmission of leptospirosis
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swallowing water contaminated with animal urine
OR Cheesing |
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tx of leptospirosis
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doxycycline or penicillin G
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what are the symptoms of Leptospirosis
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leptospiremic phase: burrowing of orgs thru-out body causes high fevers and myalgias
immune phase: appearance of IgM antibodies, neck stiffness due to elevated WBCs in CSF |
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what is the only rickettsial dz without a rash
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Q fever....caused by Coxiella burnetti
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tx of bartonellosis
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erythromycin (macrolides)
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what kind of tx do you give rickettsia and why?
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protein synthesis inhibitors like tetracyclines
bc its an obligate intracellular bacteria |
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do you get an eschar in RMSF?
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usually not found
other forms of rickettsia, all typhus yes! |
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what causes typhus? what is the vector?
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rickettsia prowa(R)zekii
human body louse |
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symptoms of rickettsialpox?
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back pain with rickettsialpox
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what is Brills Zillner Dz?
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reactivation of latent typhus,
non-specific febrile dz w/ NO rash |
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What 3 dz can be transmitted by body louse?
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Relapsing fevers (borrelia recurrentis)
Typhus (rickettsia prowarzekeii) Bartonella quintana (trench fever) sidenote Bartonella henselae is transmitted by cats (cat-scratch fever) |
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what are 3 dz transmitted by ixodes tick?
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erlichiosis
babesia lyme |
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types of cells Rickettsia, ErLichia, Coxiella, and Bartonella invade AND their pathogenesis
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Rickettsia- endothelial cell-damages endothelial cells-infectious vasculitis (fever rashes)
Erlichia-Leukocytes-lysis of WBCs (fever, low WBCs) Coxiella-macrophages- lysis of Macs- pneumonia, hepatitis Bartonella- endothelial cells-prolif on surface- tumor like growths |
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Tx for Babesia?
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clindamycin plus quinine
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Ticks passing dz to eggs
Ticks that do not pass dz to eggs |
Pass-Rickettsia dzs, rickettsia
Don't pass-Lyme dz, borrelia |
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Talk abt Typhus....think Napoleon
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Napoleon's mole-black eschar
flying squirrels in russia-zoonotic reservoir in trenches-body louse son named Brills Zillner |
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how do fungi grow outside and inside you
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demonstrate dimorphism
mold outside yeast inside |
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what is it called when Tb spreads to vertebra
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Pott Disease
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MDR Tb
XDR Tb |
MDR-resistant to INH rifampin
XDR-resistant to INH, rifampin, fluoroquinolones, and another 2nd line drug |
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fecally excreted drugs
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CCC, Tigger DooDoo
Ciprofloxacin Ceftriaxone Clindamycin Tigecycline Doxycycline Daptomycin |
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pathonogmnonic finding for cryptococcus meningitis
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polysaccharide capsule
possibly melanin |
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how do pts with cryptococcus die
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meningitis, due to CSF compression
Cryptococcus forms a thick polysaccharide layer over the brain inhibiting reabsorption of CSF |
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cryptococcus gatti?
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important bc it affect immuneCOMPETENT people causing brain and lung disease
difficult to treat, high rate of recurrent infection, may need CNS shunts IRIS, Anti-tnf-a--higher rate of recurrence and persistence with gatti dz |
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what do you worry abt most in histoplasmosis?
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disseminated dz; bc its an intracellular pathogen and goes into macrophages, it can spread to any part of the body
often fulminant and fatal....depends on infecting dose...high dose, more severe clinical dz BUT..90% asymptomatic |
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where is histoplasmosis found?
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Ohio and Mississippi River valleys
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what is a common cause of pneumonia in Tucson, AZ?
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coccidioides
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what do you suspect in someone with cough of several weeks, a skin lesion, and rafting in wisconsin?
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blastomycosis
associated with riverbanks, acquired via inhalation clinical manifestations... pulmonary: most pts have indolent onset, chronic course disseminated: skin dz and bone dz |
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what is the virulence factor for blastomycosis?
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Wi-1cell adhesin
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what drug has a side effect of interstitial nephritis?
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methicillin
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Penicillium marneffei?
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3rd most common opportunistic infection in SE Asia
budding by fusion, secretes red pigment at room temp |
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Paracoccidioides brasiliensis?
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dimorphic fungus in C. and S. America
chronic mucocutaneous ulcers |
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what is the most common site for disseminated aspergillosis
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CNS
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name a mycotoxin.
what are they? What can it cause where is it found? |
aflatoxin (also mushroom poisoining, sick building syndrome)
toxic small molecules produced by many molds most common sources are grains and peanuts aflatoxin has a strong assoc with liver cancer |
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what is a major risk factor for getting candidiasis?
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neutropenia
Neutrophils are the major defense against Candida |
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what is the most common cause of death in chronic mucocutaneous candidiasis
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bacterial sepsis (from superinfection)
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What candida species would you find with an indwelling catheter (plastic)?
how would you treat |
C. tropicalis
tx: pneumoCANDins |
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what candida is resistant to AmpB?
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C. lusitania
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what candida spp are resistant to fluconazole?
what is tx? |
Tropical Cruise around the Globe
Krusei, Tropicalis, glabrata pneumoCANdins |
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aspergillosis angles?
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"A"cute
45 deg angles for branching and host response damage curve |
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how can you diagnose aspergillus?
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require tissue for diagnosis
hyphae in tissue PLUS growth in culture |
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zygomycosis angles?
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NONSEPTATE branching at 90 angles
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Clinical pres of rhinocerebral zygomycosis
Tx? |
Facial pain and headache
rapidly progressive and invasive AmpB and surgical debridement |
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3 major risk factors for zygomycosis
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Neutropenia
Diabetes Use of iron chelators (zygomycosis can scavenge this iron) |
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what is the name for fungal invasion of the nails/toes
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onychomycosis, freq due to candida, difficult to eradicate
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athletes foot
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tinea pedis
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jock itch
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tinea cruris
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malassezia furfur?
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skin pathogen,pityurass versicolor
lipophilic yeast AmpB resistant |
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Polyenes are...
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Amp B, nystatin (topical)
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how does Amp B work?
s/e what is resistant? |
form channels in cell membrane (punches holes in cell membrane)
nephrotoxicity (renal tubular acidosis-wasting of K and Mg), need to replace Mg first before replacing K C. lusitania, Malassezia furfur |
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what is the mech of flucytosine?
positives? what can it be used to treat? s/e |
antimetabolite that inhibits both DNA and RNA synthesis
excellent CSF penetration: so... tx Cryptococcal meningitis give AmpB first to punch holes then flucytosine bone marrow suppression, use only for a few weeks |
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how do azoles work?
s/e |
inhibit ergosterol biosynthesis by inhibiting fungal p-450 enzymes
prevents formation of fungal cell membranes interactions with other drugs w/cyt p450 enzymes liver failure |
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how to treat cryptococcal meningitis?
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first Amp B (punches holes) and flucytosine (antimetabolite)
then fluconazole (inhibitor of ergosterol synthesis) |
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unique toxicity of voriconazole?
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photopsia-see lights flashing
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advantage of Posaconazole?
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can be used to treat zygomycosis (its the exception)
long half-life, NO induction of p450 |
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pneumocandins mech of action?
how do you give it? s/e |
inhibits the 1,3 B-glucan synthase
Only IV!!!!b/c they are BIG! phlebitis, fever |
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how does griseofulvin work?
what does it treat? |
disrupts mitotic spindle structure (gets into TOSIS)/disrupts mitosis
GREASy skin....dermatophytes, nail infections |
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what can you treat sportrichosis?
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itraconazole, heat therapy, potassium iodide
if severe, Amp B |
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Case presentation
32 yo man with AIDS presenting with meningitis |
Cryptococcal meningitis
start with AmpB and flucytosine...then to fluconazole |
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Case presentation
3 spelunkers |
Histoplasmosis
tx with AmpB |
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Case presentation
med student who opened a petri dish or lives in dessert SW... |
Coccidioides
fluconazole, but AmpB if not sure what it is |
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Case presentation
whitewater rafter from Wisconsin with cough and skin nodule |
Blastomycosis
give Itra |
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Case presentation
woman with nodular rash after thorn injury |
Sporotrichosis
Itra |
