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218 Cards in this Set
- Front
- Back
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What organisms usually cause meningitis?
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neisseria meningitidis, GBS, strep pneumoniae
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What organisms usually cause acute otitis media?
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S. pneumoniae, h influenza and moxarella catarrhalis
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What organisms usually cause cellulitis, osteomyelitis and pyogenic arthritis?
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Staph aureus and strep pyogenes
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What are aerobic bacteria?
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Grow and live in the presence of oxygen. Ex. staph and strep
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What are anerobic bacteria?
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Cannot grow and live in the presence of oxygen. Ex. deep wounds. Characterized by abcess formation, foul smelling pus and tissue deconstruction.
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What is Gram positive bacteria?
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Has a thick layer of peptioglycan
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What are the Gram positive cocci?
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Staph aureus, staph epidermidis, strep pyogenes, strep agalactaie and strep pneumoniae
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What are the Gram positive bacilli?
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Myobacterium tuberculosis, myobacterium avium complex, corynebacterium diptheriae and listeria monocytogenes.
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What is Gram negative bacteria?
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Has a thin peptioglycan layer and an outer membrane.
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What are the Gram negative cocci?
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Moxarella catarrhalis, neisseria, n gonorrheae and n meningitidis
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What are the Gram negative bacilli?
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Chlamydia, C pneumoniae, C trachomatis, Bordetella pertussis, h influenzae and psuedomonas aeruginosa
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What are the Gram negative Enterobacteriaceae?
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Enterobacter species, e coli, klebsiella pneumoniae, proteus mirabilis, salmonella, shigella
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What are examples of Anerobes?
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Bacteroides fragilis and clostridium difficile
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What is and example of an atypical?
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Mycoplasma
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What are things that make an individual more susceptible to infection?
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Age (very young, very old)
Immunocompromised Immunization hx Prior illness Level of nutrition Pregnancy Long standing corticosteroids Severe burns Cancer/HIV |
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Explain infection by endogenous bacteria?
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When the balance is disrupted, the normal endogenous bacteria may cause disease.
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Explain infection by exogenous bacteria
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When the balance is disrupted, the normal endogenous bacteria is overgrown by pathologic exogenous bacteria.
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What are the most common causes of meningitis in newborns?
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GBS, Ecoli/Ki and other Gram negative bacteria, L monocytogenes and Enterococci
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What are the most common causes of meningitis infants and children?
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S pneuomoniae, N meningitidis and H influenza
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What are the most common causes of meningitis in children over age 5?
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S pneumoniae and N meningitidis
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What are the most common causes of Pneuomonia in birth to 20 days?
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GBS, Gram negative enterics, L monocytogenes
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What are the most common causes of Pneumonia in 3 wks to 3 mos?
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C trachomatis, S pneumoniae, B pertussis and S aureus
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What are the most common causes of Pneumonia in 4mos to 4yrs?
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S pneumoniae, H influenza, M pneumoniae and M tuberculosis
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What are the most common causes of Pneumonia in 5 to 15 yrs?
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M pneumonia, C pneumonia, S pneumonia and M tuberculosis
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What are the host factors you should consider with ABX?
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Weight, organ function (esp. liver and kidneys), Site on infection (ex. can cross blood brain barrier), common causative organisms, comorbidities, pregnancy, genetics/metabolic disease and site on infection
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What is gram staining?
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Microscopic identification of an organism. Very quick test
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What is a culture?
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Identifies causative agent and susceptibility to specific antibiotics. Take 48 to 72 hours to get results.
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What is serology?
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Titers or antibodies are measured to see if patient has been exposed
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When should a culture be done?
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Before starting antibiotic therapy
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What does sensitive mean?
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Organism should be eradicated by tx with the antiobiotic at the recommended dose
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What does intermediate mean?
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Organism may or may not be eradicated dependent on achievable drug concentration and organism MIC
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What does resistant mean?
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Organism will not be inhibited by concentrations achievable by antibiotics
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What is Minimum Inhibitory Concentration?
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Lowest concentration of antimicrobial that present visible bacterial growth in the specified medium. Predicts bacteriological response to therapy.
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What will happen in the gram stain if the bacteria is gram positive?
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Will retain the crystal violet color even when decolorized.
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What will happen in the gram stain if the bacteria is gram negative?
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Will not retain the crystal violet are decolorized and then turn pink/red.
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If someone has a nosocomial infection will they likely receive a broad or a narrow spectrum antibiotic?
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A broad spectrum antiobiotic.
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What is bactericidal?
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Destroy microbes. Kill organisms so that the number of viable organisms decreases rapidly after exposure.
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What is bacteriostatic?
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Inhibits growth but does not kill them. Need immunological mechanisms to kick in and eliminate the organism.
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Which antibiotics inhibit cell wall synthesis?
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PCNs, Cephalosporins, Carbapenems, Monobactams and Vancomycin
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Which antibiotics inhibit protein synthesis?
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Chloramphenicol, Tetracyclines, Macrolides, Clindamycin, Streptogramins, Oxazolidinones and Aminoglycosides
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Which antibiotics alter nucleic acid metabolism?
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Rifamycins and Quinolones
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Which abx inhibit folate metabolism?
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Triemthoprim and Sulfamethoxazole
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What is time dependent kinetics?
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Relies on the amount of time the serum concentration remains above the MIC. Ex. PCN, cephalosporins and vancomycin
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What is concentration dependent kinetics?
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Increased bacterial killing as the drug concentrations exceed the MIC
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What is the Post Antibiotic effect?
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Delayed regrowth of bacteria following the exposure to the antimicrobial (even though drug is below the MIC)
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What is the Minimum Bactericidal Concentration?
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Lowest concentration of an antimicrobial that kills 99.9% of the initial organism density
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What is empiric therapy?
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Selecting an agent with a broad spectrum of activity against the most likely pathogens. Presumptive tx of an infection to avoid tx delay before specific culture information has been obtained.
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What is definitive therapy?
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Specific pathogen has been identified.
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What is a superinfection?
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An infection occurring during antimicrobial tx for another infection, resulting from an overgrowth of an organism not susceptible to the abx being used.
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What are other special consideration when giving abx?
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Allergies, combination therapy, cost, abx resistance, formulary and patient response to therapy
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What are the mechanisms of resistance?
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1. Altering the target enzyme or target structure
2. Reducing permeability of cell membrane 3. Producing an enzyme that destroys abx 4. Enhanced efflux to pump abx out of cell |
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What is the MOA of PCN?
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Interferes with the last step of bacterial cell wall synthesis, inactivates pcn-binding proteins by binding to them, inhibition of transpeptidase leads to autolysis and cell death
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Is PCN bactericidal or bacteriostatic?
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Bactericidal
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Can PCN enter most body fluids?
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Yes, enters very well, inc. joint, pleural and pericardial spaces. Not effective against intraocular or CSF infections
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What is the mechanism of resistance for PCN?
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The B lactamase enzyme hydrolyzes the B lactam ring, decreased permeability of the drug through the out cell membrane
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What are the Natural PCNs?
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PCN G potassium/sodium or Pen VK. Parenteral abx of choice for susceptible organisms (ex. bacteremias, meningitis, pneumonias, syphillis)
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What are the Penicillinase resistant PCNs?
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Dicloxacillin, Methicillin, Oxacillin and Nafcillin
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What are Penicillinase Resistant PCNs used for?
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Drug of choice for staphylococcal infections
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What are the aminopenicillins?
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Amox, Ampicillin and Ampicillin/subactam
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What are aminopenicillins used for?
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Gram pos and neg cocci. Some gram neg - ecoli, h influenzae, proteus mirabilis and shigella
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What are the antipseudomonal PCNs?
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Ticacillin, Ticarcillin clavulanate, Pipercillin and Pipercillin/tazobactam
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What are antipseudomonal PCNs agents used for?
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Similar to Ampicillin, pseudomas aeruginosa, indole positive proteus species, bacteroids fragilis
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How are PCNs excreted?
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Primarily renally. Except Nafcillin, Oxacillin, Dicloxacillin which are biliarly excreted. Pipercillin is excreted both renally and biliarly
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What is the oral bioavailability of PCNs?
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OK. Amox is way better than Amp
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Is PCN well distributed to body fluids and tissues?
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Yes, very well distributed.
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When should PCNs be taken?
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On an empty stomach.
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Can PCNs penetrate the CNS?
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Only with inflammed meninges and must give high aggressive doses. More difficult to penetrate as inflammation goes down.
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Is PCN a first line tx for meningitis?
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No. Only in newborns
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What are the PCN susceptible bacteria?
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Gram positive. Strep, Staph and Enterococcus
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What are the common uses of PCN?
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Skin/soft tissue infections, UTI, upper/lower resp tract infections, bacteremia, osteomyelitis, endocarditis and STDS
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What are the adverse reactions of PCN?
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Most common is GI (diarrhea), urticaria, pruritis, angioedema, Stevens Johns syndrome, hypersensitivity, seizures, Na overload/fluid retention (Ticarcillin and Pipercillin), hypokalemia (PCN G, Ticarcillin) thrombocytopenia and thrombophlebitis
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What are the B lactamase inhibitor combos?
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Amox/Ticarcillin + Clavulanic acid = Augmentin, Timentin, Amp+Sulbactam = Unasyn, Pipercillin + Tazobactam = Zosyn
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What coverage do the B lactamase inhibitor combos have?
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MSSA, bacteroides, borrelia burgdorferi. Does not improve coverage of MRSA, enterococci, strep and pseudomonas
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What are the PCN drug interactions?
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With AG's, PCNs may antagonize the action of AG's, Probenecid inhibits the secretion of PCN, any anti-platelet agent and may cause a false positive on urine glucose.
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What organisms is Amp effective against?
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Broad spectrum abx against both gram pos and neg. Ecoli, proteus, salmonella and shigella
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What are some common uses of Amp?
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Bronchitis, sinusitis and otitis media
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What are the nursing implications of Amp?
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Same as PCN, ask about contraceptive use because may cause a decrease in effectiveness
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What is the oral equivalent to Amp?
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Amox
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How is Amox absorbed?
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Very well absorbed and reaches therapeutic levels very quickly
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What is the drug of choice to prevent bacterial endocarditis?
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Amox
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How do you dose Augmentin?
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With a higher dose of Amox and a lower dose of Clavulanic acid
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Do cephs work better against gram pos or gram neg bacteria?
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Used widely against gram negative bacteria
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Do cephs enter the placenta and breast milk?
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Yes
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Can you use a 1st generation ceph in tx for meningitis?
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No they do not reach therapeutic levels in the CSF but 2nd and 3rd generations do
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What is the MOA of cephs?
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Bind to proteins in bacterial cell wall synthesis. Interfere with cell wall synthesis.
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What is the MOA of resistance in cephs?
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Destruction by B lactamases.
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What happens as you move up generations in cephs?
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In general: lose gram positive activity and gain gram negative activity.
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Which generation of cephs have anerobic activity?
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2nd generation, Cefotetan and Cefoxitin
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What is the oral bioavailability of cephs?
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Variable but generally good - depends on the actual drug
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Which generation of cephs is best taken with food?
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3rd generation
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How are cephs excreted?
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Primarily renally, except Ceftriaxone, Cefixime, Cefaperazone, Cefotaxime (has an active metabolite)
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Which cephs can penetrate the CSF?
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Mostly 3rd generation: Ceftriaxone, Cefotaxime, Ceftazidime and Cefepime
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Which bacteria do cephs have no action against?
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Enterococci, listeria, MRSA and atypicals
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What are the common uses of 1st generation cephs?
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Skin/soft tissue infections, UTI and surgical prophylaxis
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What are the common uses of 2nd generation cephs?
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Skin/soft tissue infections, RTIs, UTIs. Cefotetan and Cefoxitin are used for OB/GYN IAI/pelvic
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What are the common uses of 3rd generation cephs?
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RTIs (strep pneumo coverage), hospital acquired pneumonia, meningitis (ceftriaxone), n gonorrhea (ceftriaxone), UTI, IAIs and pseudomonas (ceftazidime)
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What are the common uses of 4th generation cephs?
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Pseudomonas, neutropenic fever, empiric coverage and meningitis
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Which cephs can be used for meningitis?
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Ceftriaxone, Cefotaxime, Ceftazidime or Cefepime
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Which cephs can be used for neutropenic fever/pseudomonas?
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Ceftazidime or Cefepime
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Which cephs can be used for Gonorrhea?
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Ceftriaxone, Cefixime, Cefpodoxime or Cefuroxime
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Which cephs can be used for surgical prophylaxis?
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Cefazolin or Cefotetan
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What are the 1st generation cephs?
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Cefazolin, Cephalothin, Cephalexin or Cefadroxil
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What are the 2nd generation cephs?
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Cefaclor, Cefprozil, Cefuroxime Axetil, Cefuroxime, Cefamandole, Cefmetazole, Cefotetan and Cefoxitin
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What are the 3rd generation cephs?
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Cefdinir, Cefditoren pivoxil, Cefixime, Ceftibuten, Cefpodoxime proxetil, Cefoperazone, Ceftriaxone, Cefotaxime, Ceftizoxime and Ceftazidime
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What are the 4th generation cephs?
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Cefepime
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What is Keflex commonly used for?
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Skin infections
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What is the common use of Ancef?
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Surgical prophylaxis
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What are 1st generation cephs active agains?
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Gram positive bacteria, strep and staph
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Can Cephazolin (Ancef) be used in the tx of meningitis?
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No, has minimal CSF penetration
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Besides surgical prophylaxis, what is Cephazolin (Ancef) used for?
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UTI, bone and skin infections and endocarditis
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What is the Peds dosing for Ancef surigcal prophylaxis?
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30mg/kg/dose within 60 mins of incision
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What types of bacteria are 2nd generation cephs active against?
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More gram negative bacteria than 1st generation and anerobic organisms
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Can 2nd generation cephs penetrate the CSF?
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Penetration is poor but adequate to tx meningitis
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What types of bacteria are 3rd generation cephs active against?
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Similar to 2nd generation cephs but have increased activity against gram negative
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Can 3rd generation cephs penetrate the CSF?
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Yes
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What are the adverse effects of cephs?
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Possible increase in LFTs, superinfection, GI - antiobiotic associated colitis, bleeding reactions
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If someone has a severe PCN allergy can they get a ceph?
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NO
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Can someone under 3 mos get Ceftriaxone?
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No because of biliary sludging
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Which ceph causes a disulfuram reaction?
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Cefotetan
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What are the drug interactions of cephs?
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Cephs are antagonized by abx with bacteriostatic actions, AG's: cephs may antagonize AG action
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Do Carbapenems have a narrow spectrum of activity?
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No, they have a broad spectrum of activity
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What are Carbapenems often used for?
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Complicated body cavity and connective tissue infections in the hospitalized patient
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What drugs are Carbapenems?
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Imipenem-cilastatin
Meropenem Doripenem Ertapenem |
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Which is the only Carbapenem that can be used to tx bacterial meningitis?
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Meropenem
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What is the MOA for Carbapenems?
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Inhibit bacterial cell wall synthesis
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What is the MOA of resistance for Carbapenems?
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Destroyed by B lactamase enzymes
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How are Carbapenems administered?
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IV or IM only
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T or F: Carbapenems have poor tissue penetration
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False, have no good tissue penetration, including the CSF
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What are the common uses of Carbapenems?
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Serious and life threatening infections, very broad spectrum, bacteremia, sepsis, hospital acquired pneumonia, intra-abdominal infections, febrile neutropenia, gram negative meningitis
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T or F: Carbapenems are commonly used for more resistant organisms
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True
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What is Ertapenem used for?
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UTI, skin/soft tissue infections and pneumonia. Has a more narrow spectrum that other Carbapenems
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What are the adverse reactions for Carbapenems?
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Hypersensitivity, Seizures (imipenem most likely to cause), N/V
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Drug interactions of Carbapenems
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Epileptogenic drugs, nephrotoxins
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What bacteria can Aztreonam treat?
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Gram negative only
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What type of drug is Aztreonam?
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A Monobactam
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Does Aztreonam cover Pseudomanas?
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Yes
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What are the common uses of Aztreonam?
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UTI, pneumonia, pelvic/peritoneal infections and sepsis
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How can Aztreonam be administered?
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IV only
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Does Aztreonam penetrate the CNS?
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Yes with inflammed meninges but is not 1st line tx for meningitis
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Can a patient with a PCN allergy be given Aztreonam?
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Yes
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What is the non-nephrotoxic alternative to to AG's
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Aztreonam
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What is the most commonly used drug to tx MRSA?
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Vancomycin
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What is the MOA of Vancomycin?
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Inhibits cell wall synthesis by inhibiting the 2nd start of peptidoglycan synthesis
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What is the spectrum of activity of Vancomycin?
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Gram positive only (strep, staph and enterococci), considered a broad spectrum gram positive agent
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What is the MOA of resistance for Vancomycin?
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Increases cell wall thickness and Vanc gets trapped
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How is Vanc absorbed?
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V poor absorption with PO administration because collects in gut lumen, cannot tx systemic infections this way
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T or F: Vanc is widely distributed into body fluids so a higher dose will be needed in patients with a higher volume of water
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True
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What is the 2nd line tx for Cdiff?
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Vancomycin PO
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T or F: Vanc has concentration dependent killing
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False, has time dependent killing
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When should troughs for Vanc be drawn?
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Prior to the next dose being given
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When are peak levels of Vanc drawn?
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1 hour after administration but are not usually helpful
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What bacteria are susceptible to Vanc?
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Gram positive bacteria (strep, enterococcus and staph)
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What are the common uses of Vanc?
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Skin/soft tissue infections
UTIs RTIs Bacteremia Endocarditis Osteomylitis STDs Resistant gram positive infections (MRSA) Pts with PCN allergy CDiff |
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What is Red Man Syndrome?
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Reaction (not allergic) to Vanc, erythematous rash of head, face, neck and upper trunk, with hypotension. Usually happens when infused too quickly.
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How do you tx Red Man Syndrome?
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Antihistamine and/or slow rate of infusion
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Is Vanc nephrotoxic and ototoxic?
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Yes
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Which drugs are Macrolides?
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Erythromycin, Azithromycin and Clarithromycin
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Why are Azith and Clarith better than Eryth?
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Dosing is less frequent, GI effects are decreased and they are better absorbed
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What is the MOA of Macrolides?
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Inhibit RNA dependent protein synthesis via binding to 50S ribosome
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What is the MOA of resistance to Macrolides?
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Alternation of ribosomal subunit, penetration into cell wall, effects efflux pump
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Where are Macrolides absorbed?
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In the duodenum, so it's diff to give to pts with GI tube
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T or F: gastric acidity causes partial inactivation of Macrolides
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True
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How are Macrolides eliminated?
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Primarily via bile and liver.
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T or F: Macrolides are bactericidal
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False they are bacteriostatic
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Which Macrolide has the fewest drug interactions?
|
Azithromycin
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T or F: Erythromycin is active against staph and strep
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False, not reliable to use against staph
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What types of bacteria are Macrolides active against?
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Have some gram negative and some gram positive activity
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Which Macrolides are effective against additional G negatives (ex. H influenza, Neisseria sp, M Catarrhalis, h pylori and B burgforderi)
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Clarithromycin and Azithromycin
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T or F: Clarith and Azith can be used against MAC, Toxo and H flu
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True
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What are the common uses of Macrolides?
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Upper and Lower RTIs, skin and soft tissue infections (esp otitis media), endocarditis prophylaxis and H pylori (Clarithromycin)
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What are the adverse reaction to Erythromycin?
|
Prolonged QT (with azoles)
GI upset, diarrhea Cholestatic hepatitis |
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What are the adverse reactions to Erythromycin inj?
|
Thrombophlebitis
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What are the adverse reactions to Clarithromycin?
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Metallic taste
GI upset Diarrhea |
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Which enzymes do Eryth and Clarith inhibit?
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CYP3A4 and 1A2
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Which drugs to Eryth and Clarith interact with?
|
Warfarin
Simvastatin Theophylline Digoxin Corticosteroids Carbamazepine, phenytoin Some benzos Cyclosporine, Tacrolimus |
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Are AGs bacteriostatic?
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No they are bactericidal
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What drugs are AGs?
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Gentamicin
Tobramycin Amikacin Neomycin |
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What is the MOA of AGs?
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Inhibit bacterial protein synthesis by binding to the 30S subunit. Become unable to synthesize protein.
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What is the MOA of resistance of AGs?
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Ezymatic activation
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Which AG has the most resistance? Which has the least?
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Gentamicin has the most resistance, Amikacin has the least resistance
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T or F: AGs have nonlinear kinetics?
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False, they have linear kinetics
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When should a peak be measured in AGs?
|
30 mins after infusion
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T or F: AGs are highly lipid soluble
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False they are water soluble so newborns need a higher dose
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Where is there good tissue penetration of AGs?
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Good in synovial fluid, abcesses, placenta and well perfused organs
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Where is there poor penetration of AGs?
|
The CNS and bronchial sputum and secretions
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How are AGs eliminated?
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Renally
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Do AGs have a post antibiotic effect?
|
Yes
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What's the best way to dose AGs and why?
|
Once daily dosing is more effective and safer because AGs have concentration dependent killing
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Who can't have extended interval dosing with AGs?
|
Elderly, pregnant or post partum, renal insufficiency, severe liver disease, ascites, ototoxicity, hearing problems, endocarditis, CF, extensive burns, severe fluid overload states
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What are the common uses of AGs?
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Gram negative infections alone or in combo with another drug
Urosepsis Synergistically for gram + infections Aerosolized for CF gram - colonization |
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What are the adverse reactions of AGs?
|
Neuromuscular blocking effect
Caution with dehydration Nephrotoxicity Ototoxicity Endotoxin like reactions (shaking, fever, chills) |
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AG Drug Interactions
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Antimyasthenics: antagonize the effects
Neuromuscular blocking agents Beta Lactam abx: may inactivate AGs Nephrotoxic/Ototoxic meds |
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What drugs are Floroquinolones?
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Ciproflaxacin
Levoflaxacin Moxifloroxacin Norfloxacin Ofloxacin |
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What is the spectrum of activity of Quinolones?
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Gram negative organisms, enterobacteriaceae
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Cipro and Levo are also effective against....
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P aeruginosa
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Newer Quinolones (Levo and Moxi) are active against
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Strep pneumonia
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T or F: Moxi has some activity against anerobic bacteria?
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True
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Which drugs are good to give to CF pts with pseudomonas?
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Quinolones
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Why are Quinolones not the first line therapy for anything?
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Because they cause cartilage damage
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What is the MOA of Quinolones?
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Destroys bacteria by altering their DNA
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What is the MOA of resistance for Quinolones?
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Alters membrane permeability and activates the efflux pump
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Are Quinolones well absorbed?
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Yes well absorbed with PO but there is impaired absorption when given with a multivalent cation (ex. calcium)
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Which Quinolone is highly metabolized by the liver?
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Moxi
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How are Quinolones eliminated?
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Predominantly renally
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What are the common uses of Quinolones?
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Chronic Infections
Deep Tissue (anerobic) infections MRSA UTI, prostatitis Inta-abdominal infections Febrile Neutropenia Travelers Diarrhea Skin/soft tissue infections (levo and moxi) RTIs Hospital acquired RTI (cipro and levo) Community Acquired RTI (levo and moxi) |
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Can you give a patient with a PCN allergy a Quinolone?
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Yes
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What are the adverse reactions to Quinolones?
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GI, N/V
Rashes Photosensitivity Arthropathy Tendonitis Elevated liver enzymes QT prolongation CNS - Dizziness, hallucinations, delirium and seizures |
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What are the drug interactions with Quinolones?
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Separate by 2 hours from a multivalent cation (ex. calcium, iron, magnesium)
Theophylline Caffeine Cyclosporine Phenytoin |
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What class of drug is Clindamycin?
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Lincosamide
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What is the MOA of Clindamycin?
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Binds to 50S subunit
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What is the spectrum of activity of Clindamycin?
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Gram positive and anerobic organisms only
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What bacteria does Clindamycin work against?
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Strep, staph, fusobacterium, peptostreptococcus, peptococcus, C perfringes, B fragilis and gardnerella
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What are the clinical uses of Clindamycin?
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Skin/soft tissue infections
Staph and strep Acne Option for PCN allergy pts |
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T or F: Clindamycin is not well absorbed
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False, it is nearly completely absorbed
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Does Clindamycin distribute into the CNS?
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No
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How is Clindamycin excreted?
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Underdoes extensive liver metabolism, excreted in bile and urine
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Is Clindamycin bacteriostatic?
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Yes but it can become bactercidal at very high concentrations
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What are the adverse effects of Clindamycin?
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Diarrhea
Pseudomembranous colitis Rash Elevated liver enzymes |
