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137 Cards in this Set
- Front
- Back
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Pen G/V
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Erysipelas (streptococcus)
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Amoxicillin
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Erysipelas (streptococcus)
Extended spectrum antibiotic |
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Celphalexin
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Erysipelas (streptococcus)
Cellulitis (streptococcus) MSSA |
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Clindamycin
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Cellulitis (streptococcus)
Good for people allergic to beta lactams Moderate MRSA |
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Amoxicillin + clavulanic acid
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Cellulitis (Streptococcus)
MSSA |
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Azithromycin
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Allergic to beta lactams
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Clarithromycin
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Allergic to beta lactams
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Nafcillin
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MSSA
Beta lactamase resistant penicillin |
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Oxacillin
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MSSA
Beta lactamase resistant penicillin |
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Dicloxacillin
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MSSA
Beta Lactamase resistant penicillin |
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3rd Generation Cephalosporins (Ceftriaxone)
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Severe MSSA
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TMP-SMX (Trimethoprim + sulfamethoxazole)
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Mild to moderate MRSA
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Doxycycline
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Moderate MRSA
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Minocycline
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Moderate MRSA
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Vancomycin
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Severe MRSA
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Linezolid
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Severe MRSA
Strep + MRSA |
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Daptomycin
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Severe MRSA
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Amoxicillin + TMP-SMX
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Strep + MRSA
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Amoxicillin + docycycline
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Strep + MRSA
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Amoxicillin + minocycline
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Strep + MRSA
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Ceftaroline
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Strep + Staph (Severe infection, assume MRSA)
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Enzyme responsible for cross linking peptidoglycan in cell walls.
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Transpepsidase
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The Gram + cell wall is comprised of a thick, homogenous sheath of _______ whose ______ _____ _____ add rigidity.
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Peptidoglycan, peptide cross links
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The Gram - cell wall has a _____ peptidoglycan layer that has a _____ _________ outside of it.
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Thin, outer membrane.
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The outer membrane of Gram _____ organisms is known as the _________ barrier.
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Negative, permeability
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Beta lactamases and other molecules are contained in the ______________ of Gram negative organisms.
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Periplasmic space
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Backbone of alternating NAM and NAG sugars with amino acid side chains that compose the cell wall of gram + organisms.
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Peptidoglycan
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These crosslink NAM subunits.
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Tetrapeptide side chains of NAM subunits
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_____ _____ of amino acids link tetrapeptides of amino acid side chains of NAM sugars in peptidoglycan.
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Cross bridges
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Carrier protein that links onto the building blocks of peptidoglycan (NAM and NAG) to transport them across the membrane.
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Bactoprenol
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_____________ binds tightly to the ala-ala peptides of NAM subunit and preventing cross linking of peptidoglycan.
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Vancomycin
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__________ prevents the phosphate from coming off bactoprenol carrier protein, which prevents the bacterium from exporting building blocks for peptidoglycan through the cell membrane. This prevents the recycling of bactoprenol.
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Bacitracin
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Transpepsidases bind the ________ amino acid of one NAM subunit to the ____________ amino acid of another NAM subunit.
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Lysine, alanine-alanine
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__________ competes for the enzyme transpepsidase, which binds to the drug instead of the alanine and prevents cross linking of peptidoglycan.
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Penicillin
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What is another name for a transpeptidase?
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Penicillin Binding Protein
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Methicillin
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MSSA
Beta lactamase resistant penicillin |
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Ampicillin
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Extended spectrum penicillin
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Penicillin G is _______ and has ________ bioavailability.
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Acid-labile, poor
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Penicillin _ has better bioavailability than penicillin _ because it is more stabile in acid.
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V, G
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_______ extending from the beta lactam ring determine the identity and effect of the drug.
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R groups
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Penicillin G is highly active against ___________ cocci and Gram _____ rods, as well as most ________.
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Gram positive and negative, negative, anaerobes
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Pen G is NOT active against _______________ because of poor penetration through the porin channel.
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Gram - bacilli
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Why is Pen G effective against Gram - cocci?
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They have very little external membrane.
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___% of staphylococcus aureus and most ___________ __________ are now resistant to Pen G
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More than 90%, Neisseria conococci
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Is Pen G time dependent or concentration dependent?
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Time dependent
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Pen G has a very _______ half life of ________ minutes.
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Short, ~30
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Pen G ________ and __________ are used to decrease injection frequency through slow release from the drug site.
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Procaine, benzathine
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Penicillins that yield low but prolonged drug levels are called:
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Repository Penicillins
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The most common adverse effect of penicillin is ______________.
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Allergic (hypersensitivity) reactions
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___________ is a breakdown product of Pen G that acts as a hapten.
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Penicilloic acid
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True or false: If you are allergic to one of the penicillins, then you are allergic to all of them, and sometimes to cephalosporins as well.
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True
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What are some non-allergenic adverse effects of penicillin?
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Diarrhea, GI intolerance, neurotoxicity (coma, seizures, hyper-reflexia)
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What is the most common resistance component with regards to penicillin?
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Penicillinase production
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The mutation of ______________ (such as in the case of MRSA) prevent beta lactams from binding to their target
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Transpeptidases
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Some examples of intrinsic resistance to penicillin are __________ organisms, which keep penicillin from entering the cell, and __________, which don't have cell walls and therefore no target.
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Gram -, mycoplasma.
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______________ cleave the beta lactam ring of beta lactam drugs, rendering them ineffective.
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Beta lactamases
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Gram positive organisms secrete beta lactamases _______ of the cell wall in _______ concentrations and are primarily __________ transmitted.
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Outside, high, Plasmid (R) factor
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Gram negative organisms contain beta lactamases in their _________ in ________ concentrations.
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Periplasmic space, high.
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Plasmid mediated beta lactamases mediate resistance to the _________ and ___ and ___ generation cephalosporins.
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Penicillins, 1st, 2nd
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Extended spectrum beta lactamases (ESBL) are found in gram __ organisms and efficiently hydrolyze ________, ___________ generations _ through _, and ___________.
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Negative, penicillins, cephalosporins 1-4, monobactams (aztreonam)
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_____________ such as ____________ are the best agents for infections caused by ESBL producing organisms.
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Carbapenems (imipenem)
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The most common ESBL producers are _________ and ________.
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Klebsiella pneumoniae, E. coli
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Beta-lactamase resistant penicillins are resistant because of their ____________.
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Bulky side chains that don't fit into the beta lactamase active site
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The four drugs of choice for MSSA (that are also active against strep) are:
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Methicillin
Oxacillin Dicloxacillin Nafcillin |
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Antistaphylococcal agents such as nafcillin, methicillin, oxacillin and dicloxacilin can cause adverse side effects such as blood ______ (agranulocytosis), acute _______ _________, and _____________.
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Dyscrasia, interstitial nephritis, hepatotoxicity.
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Extended spectrum penicillins such as _______ and ________ more readily penetrate the ________ channel, so they are often used in Gram ____ infections such as E. coli and N. meningitidis.
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Ampicillin, amoxicillin, porin, negative.
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Extended spectrum penicillins are not effective against __________, so they are administered with ________ to extend their spectrum of activity.
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Beta lactamases, beta lactamase inhibitors.
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Which has better bioavailability: amoxicillin or ampicillin?
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Amoxcillin has F >75%, which is much better than ampicillin.
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Ampicillin is frequently used (synergistic) with _____________ such as ____________ for broad range coverage in serious infections.
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Aminoglycoside, gentamicin.
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__________ is the DOC for Listeria meningitidis
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Ampicillin
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These bind to beta lactamase and inactivate the enzyme because they look like a penicillin. This extends a penicillin drug's spectrum against lactamase producers such as Staphs and Klebsiella.
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Beta lactamase inhibitors
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Beta lactamase inhibitors look like a _______(though they have poor intrinsic antimicrobial activit), so they bind to the _________ and inactivate it. They are __________ inhibitors, so their binding is ___________.
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Penicillin, beta lactamase, suicide, irreversible.
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Beta lactamase inhibitors are active against _______ encoded beta lactamases, but not against ________ beta lactamases induced by G- bacili by 2nd and 3rd generation cephalosporins.
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Plasmid, chromosomal
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The only oral prep of a beta lactamase inhibitor and antibiotic is _______ + ________.
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Amoxicillin + clavulanic acid (augmentin)
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Ampicillin + sulbactam
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Beta lactamase inhibitor combination prep
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Ticarcillin + clavulanic acid
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Beta lactamase inhibitor combination prep
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Piperacillin + tazobactam
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Beta lactamase inhibitor combination prep
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Which is more susceptible to breakdown by beta lactamases: penicillins or cephalosporins?
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Penicillin
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_________ account for a large percentage of superinfections due to very frequent use.
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Cephalosporins
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ESBL can break down both ______ and _______.
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Penicillins, cephalosporins
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New infection appearing during antibiotic treatment for a primary infection. The organism becomes resistant to the antibiotic used for the primary infection.
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Superinfections
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____________ is an example of a superinfection and is responsible for causing pseudomembranous colitis.
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Clostridium difficile
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A superinfection caused by _____________ results in enterocolitis.
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Staphylococcus aureus
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A superinfection caused by _________ causes thrush in the vagina and the mouth.
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Candida albicans
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____________ are frequently used for surgical prophylaxis
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1st generation cephalosporins
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As the generations of cephalosporins go on, you gain more Gram _____ activity and less gram ____ activity. You also gain increasing activity against _______ and increased resistance to _________.
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Negative, positive, anaerobes, beta lactamases.
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The third generation of cephalosporins is very important because it has the ability to ___________.
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Cross the blood brain barrier and treat CNS infections
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____________ are an alternative dry for patients with staph or strep infections who are allergic to all beta lactam antibiotics.
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Macrolides
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________ are used for patients allergic to antistaph penicillins such as oxacillin, nafcillin and diclox.
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First generation cephalosporins
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1st generation cephalosporin often used in prophylaxis of surgical procedures
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Parenteral Cefazolin
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First generation cephalosporins are very active against _______ organisms, specifically staph aureus and strep.
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Gram positive
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Name an example of a 5th generation cephalosporin that is active against both Gram + and Gram - organisms.
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Ceftaroline
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Cephtaroline is a __ generation cephalosporin that is specifically for skin and skin structure infections caused by ________, ________, _______ or ______, as well as ___________.
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5th, S. aureus (MSSA and MRSA), S. pyogenes, Klebsiella, E coli, community acquired pneumonia.
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______________ is a beta lactam antibiotic that will recognize the MRSA mutated transpepsidase.
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Ceftaroline
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The only oral use of vancomycin is for __________ infections such as _______ or ______. It is otherwise dosed parenterally.
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GI, C. diff, enterocolitis caused by S. aureus
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Vancomycin binds tightly to _______________ end of the peptidoglycan petapeptide and inhibits ________, which prevents the building block bound to the phospholipid carrier from binding to the growing peptidylglycan chain.
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Alanine-alanine, transglycosylase
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High level resistance to vancomycin occurs through a protein that creates a ____________ rather than the normal alanine alanine linkage in the cell wall. This resistance is transferred via ________ and is usually ______ mediated.
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Alanine-lactate, conjugation, plasmid
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Vancomycin is limited to Gram ____ organisms.
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Positive
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The drug of choice for MRSA is _________. This drug is also the DOC for Enteriococci.
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Vancomycin
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The drug of choice for C. diff is __________.
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Metronidazole
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Vancomysin is associated with ___________ and _________, and must be used with caution when used in combination with other agents with similar effects such as amino glycosides.
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Ototoxicity, nephrotoxicity.
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Red man or red neck syndrome occurs due to a _________ release (direct effect on _____ cells) with rapid infusion of ____________. This can be prevented with slow infusion
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Histamine, mast, vancomycin.
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Daptomycin has activity very similar to _____________, in that it is effective against Gram ___ bacteria such as S. aureus and Enterococcus faecailis/faecium and vancomycin resistant enterococci.
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Vancomycin, positive.
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____________ is indicated in cases of complicated skin and skin structure infections, bacteremia, endocarditis and other severe infections caused by MRSA and VRE
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Daptomycin
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The mechanism of action for daptomycin is unique in that it binds to ____________________ and causes rapid ___________ and subsequent loss of _________, which results in cell death.
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Bacterial membranes, depolarization, membrane potential.
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Is daptomycin time dependent or concentration dependent?
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Concentration
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Daptomycin can cause skeletal muscle damage (________). Look for elevations in _______, an enzyme found mainly in the heart, brain and skeletal muscle.
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Myopathy, creatine phosphokinase
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Daptomycin can cause ___________ and/or _____________.
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Superinfection or pseudomembranous colitis
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TMP + SMX is a fixed dose combination that is ________; it interacts in ways that enhance or magnify their effects.
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Synergistic
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TMP is usually: bactericidal, bacteriostatic?
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Bactericidal
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Sulfonamides compete with _______ for dihdropteroate synthase, while trimpethoprim competes with _________ for dihydrofolate reductase. Both prevent the production of ____________.
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p-Aminobenzoic acid (PABA), dihydrofolate, tetrahydrofolate.
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Bacteria cannot use __________ _________; they must make it.
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Exogenous folate
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A unique adverse effect of sulfonamides is __________, which displaces ___________ from plasma albumin. This bilirubin deposits in the ____________ and subthalmic nuclei of the brain and causes ________________.
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Kernicterus, bilirubin, basal galnglia, encephalopathy
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__________ have one of the broadest antimicrobial spectrums, including G+, G-, anaerobic and aerobic organisms alike.
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Tetracyclines
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__________ are the DOC for mild to moderate MRSA, Mycoplasma p. Chlamydia, Rickettsiae and Bacillus anthracis
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Tetracycline
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Doxycycline
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DOC for Plague, tularemia, brucellosis, malaria prophylaxis
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Tetracyclines are: bacteriostatic or bactericidal?
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Bacteriostatic
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Tetracyclines __________ bind with the 30S ribosomal subunit, which prevents _______ from binding to the acceptor site. This prevents addition of _________ to growing peptides.
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Reversibly, tRNA, amino acids
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Tetracyclines + penicillins = ____________
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Antagonism
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Tetracyclines stop __________, thus interfering with penicillins, which require it.
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Bacterial growth
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Vancomysin or beta lactams + aminoglycosides = ___________
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Synergistic
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The primary method of resistance to tetracyclines are ________ and ___________, where proteins dislodge tetracycline from the ribosome and increase the apparent Kd of the drug.
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Efflux pumps and ribosome protection
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Very broad spectrum tetracycline effective in resistant organisms such as MRSA, S. epidermis, penicillin-resistant s. pneumoniae (PRSP), VRE
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Tigecycline
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Tetras form stable ________ with cations, so you shouldn't take them with milk, antacids or peptobismol.
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Chelates
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Tetracyclines bind to ________, which is readily available in the _____ and ________ of young children and feti. This may result in permanent discoloration of the teeth.
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Calcium, bones, teeth.
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Inhibit protein synthesis by acting at the 50S ribosomal subunit.
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Lincosamides
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Aerobic G- bacili are intrinsically resistant to _________
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Clindamycin
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Clindamycin is: bacteriostatic or bactericidal?
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Bacteriostatic
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Resistance to clindamycin includes the alteration of the ____________ binding site, primarily by __________.
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50S binding site, methylation.
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Adverse effects to clindamycin include severe ________ and _______________.
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diarrhea, pseudomembranous colitis
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Clindamycin is an example of a ______________.
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Lincosamide
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Linezolid is an example of a
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Oxazolidinone
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Linezolid is only active against _____ bacteria.
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Gram positive
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Linezolid is a DOC for ________ and __________.
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MRSA, vancomycin resistant enterococcus
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The mechanism of action for Linezolid is _________________, where it binds to the _________ and blocks initiation complex.
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Protein synthesis inhibitor, 50S subunit.
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Linezolid is mostly __________, but it is __________ for streptococci.
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Bacteriostatic, bactericidal
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The mechanism of drug resistance for linezolid is ________________.
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Mutation of the rRNA binding site
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