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160 Cards in this Set
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presence of a fever:
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> 100.4
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wbc:
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5-10 x ^3 cells/mm^3
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pmns:
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50-80%
mature |
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bands:
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3-5%
immature |
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lymphs:
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20-40%
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monos:
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2-8%
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eos
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0-4%
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baso
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0-1%
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increased wbc
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leuckocytoisis
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what's L shift
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an increase in band cells
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pcnases class 2a: pathogens?
tx |
staphylococcus
tx: b-lactamases inhibitors combos or pcnase resistant pcns |
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broad spectrum class 2b pathogen:
tx? |
e coli, klebsiella, proteus sp
tx; bl inhibitor combos, 2nd and 3rd gen |
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ESBL pathogens:
tx? |
e coli, klebsiella
tx: carbapenems, tigecycline, cephamycins, fluoroquinolones |
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t/f
fluoroquinolones are broken down by blactamases |
f
but they are sensitive to e coli, so they'll help w/ esbl |
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amp c beta-lactamases class 1 pathogens?
tx |
enterobacter, citrobacter, serratia
tx: carbapenems, cefepime, fluoroquinolones, tigecycline |
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what shouldn't u use w/ amp c beta-lactamases class 1?
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ceftazidime
clavulanate cephalosporins cuz they're inducible |
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why ok to tx amp c blactamases w/ fluoroquinolones and tigecycline
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they're not beta lactams
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why ok to tx amp c blactamases w/ carbapenems
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they induce but they still kill
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carbapenemases class 3 pathogens
tx: |
pseudomonas
aceinetobacter tx: older polymixins |
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natural pcns
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pcn VK (oral)
pcn G procaine benzathine salts |
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t/f
natural pcns are not b lactamase susceptible |
f
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spectrum of natural pcns
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streptococcus sp
enterococcus mouth anaerobes |
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|
natural pcns are the doc for which diseases
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syphilis
beta-hemolytic streptococci clostridia pharyngitis infections of the mouth |
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aminopcns
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ampicillin (IV and PO)
amoxicillin |
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t/f
aminopcns are blactamase susceptible |
t
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spectrum of aminopcns
|
streptococcus sp
enterococcus mouth anaerobes non-beta lactamases producing H flu e coli proteus mirabilis salmonella shigella neisseria gonorrhea listeria |
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amionpcns are the doc for:
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enterococcal
stre infections gram neg h pylori |
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aminopcns w/ b-lactamase inhibitors
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ampicillin and sulbactam iv
amoxicillin + clavulanate |
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what do aminopcns w/ b-lactamase inhibitors cover
|
add b-lactamase producing pathogens:
staphcoccus sp. . MSSA (NOT MRSA) gram neg anaerobes |
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aminopcns w/ b-lactamase inhibitors does not add coverage if the resistance is due to alteration in ----- or decreased cell wall -----
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pbp
permeability |
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doc for aminopcns w/ b-lactamase inhibitors
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empiric tx for aspiration pneumonia
when staph and strep are suspected |
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pcnase resistant pcns
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oxacillin IV
nafcillin IV dicloacillin PO |
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pcnase resistant pcns are stable in the presence
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b lactamases
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|
|
spectrum of pcnase resistant pcns
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streptococcus sp
staphylococcus sp (NOT MRSA) |
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clinical use of pcnase resistant pcns
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skin and soft tissue infections
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|
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extended spectrum pcns:
|
pipercillin
ticarcillin |
|
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t/f
extended spectrum pcns are not b lactamase susceptible |
f
they are |
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spectrum of extended spectrum pcns:
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non-beta lactamase producing gram neg including:
pseudomonas sp klebsiella sp enterobacter serratia |
|
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what are extended spectrum pcn usu used for
w/ what |
pseudomonas
usu w/ amionglycosides or fluoroquinolones |
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extended spectrum pcns w/ beta-lactamase inhibitors:
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piperacillin + tazobactam
ticarcillin + clavulanate |
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spectrum of extended spectrum pcns w/ beta-lactamase inhibitors:
|
same as extended spectrum: pseudomonas, klebsiella, enterobacter, serratia
staphylococcus anaerobes including b fragilis |
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what pcns can cause heptotoxicity
|
oxacillin
naficillin |
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pcn di
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probenecid
aminoglycosides (don't give in same IV line) |
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b lactamase inhibitors
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sulbactam
clavulanic acid tazobactam |
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t/f
b lactamase inhibitors has strong antibacterial activity alone |
f
weak |
|
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b lactamase inhibitors increase the spectrum of pcn to include:
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b lactamase producing bacteria only if pcn active against the bacteria w/o the b-lactamse
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which is more inactivated by b lactamases
cephalosporin or pcn |
pcn
|
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no fda approved cephalosporins covers -----
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enterococcus
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first gen ceph
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cefazolin (IV)
cephalexin PO cefadroxil PO |
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spectrum of 1st gen ceph
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MSSa
klebsiella e coli proteus mirabilis |
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1st gen ceph are doc for
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surgical prophylaxis
uncomplicated ssti mssa infections |
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which b lactamses are ceph stable in the presence of
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staph
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2nd gen ceph
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cefuroxime PO/IV
cefpodoxime PO cefdinir PO ceftibuten PO |
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spectrum of 2nd gen ceph
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staph/strep
h flu klebsiella e coli proteius mirabilis NO anaerobes |
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which ceph is the doc for h flu
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2nd gen PO's
(cefuroxime, cefpodoxime, cefprozil, cefdinir, ceftibuten) |
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t/f
2nd gen ceph will tx anaerobes |
f
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2nd gen cephs IV's
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cephamycins:
cefotetan IV q 12h cefoxitin IV q 6-8 h |
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spectrum of 2nd gen cephs IV's
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staph/strep
e coli klebsiella proteus anaerobes (GI SX) |
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which cephalos are doc for abd procedures
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2nd gen IV's
cefotetan cefoxitan |
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clinical use of 2nd gen cephs: IV
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tx of mild infections due to ESBL
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which cephs tx ESBL
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2nd gen IV
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3rd gen cepha that txs steptococcus pneumoniae including prsp, h flu, klebsiella, e coli, proteus, and some staph (not MRSA)
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ceftriaxone
cefotaxime |
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ceftriaxone
cefotaxime used to tx |
streptococcus pneumonia including prsp
h flu klebsiella e coli proteus staph coverage (not mrsa) |
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ceph that's doc for CAP, meningitis, endocarditis
|
3rd gen ceph
ceftriaxone cefotaxime |
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ceftriaxone and cefotaxime stabe for some -------- and active against most
|
beta lactamases
prsp |
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3rd gen cephs used to tx gram neg including pseudomas and are weak against gram pos
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ceftazidime
ceftizoxime |
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what pathogens are ceftazidime and ceftizoxime used to tx
|
3 rd gen ceph
gram neg including pseudomonas |
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ceftazidime and ceftizoxime tx
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febrile neutropenia
nosocomial infections where pseudomonas are suspected (ex meningitis) |
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t/f
ceftazidime and ceftizoxime are 1st line |
f
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t/f ceftazidime and ceftizoxime used to tx amp c beta lactamases
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False!!!
this will induce them |
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4th gen cephs
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cefepime
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4th gen cephs spectrum
|
staph/strep
gram neg: pseudomonsa/enterobacter/acinetobacter/ ampC extended producing organisms |
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which ceph used to tx amp c
which ceph should you not use to tx amp c |
tx amp c: 4th gen: cefepime
NOT used to tx amp c: 3rd gen: ceftazidime/ceftizoxime |
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t/f
4th gen cover anaerobes |
f
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what dose of cefepime to use for pseudomonas?
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higher doses
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4th gen ceph used for empiric coverage of ---- ---- and ---- infections
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febrile neutropenia
polymicrobial infections |
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which gen ceph has the most cross sensitivity w/ pcns
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1st gen
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which cephs can cause seizures
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ceftazidime
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which ceph can cause cholithiasis and biliary sludging
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ceftriaxone. . . 3rd gen
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carbapenams are stable in the presence fo most ---- ---
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beta lactamases
can use to tx w/ some b lactamases |
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imipenem given w/
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cilastin
prevent nephrotoxicity |
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imipenem stable to most beta-lactamases except ----
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metallo-betalactamases. .. carbapenemases
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imipenam spectrum
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gram pos (not MRSA or E faecium)
gram neg (not stenotrophomonas) anaerobes |
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clinical use imipenem
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broad spectrum of polymicrobial infections
ESBL AMP C producing organisms febrile neutropenia |
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meropenem similar to
|
imipenem
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which has better coverage of pseudomonas imi or mero
|
meropenem
|
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which has better coverage of enterococcus
imi or mero |
imi
|
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clinical use of mero
|
broad spectrum coverage of polymicrobial infections
esbl amp c producing organisms febrile neutropenia meningitis |
|
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what used if othe empiric carbapenems done work
|
ertapenem
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t/f ertapenemem susceptible to amp c or esbl
|
t
although has high MIC |
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spectrum for ertapenem:
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gram pos except MRSA
enterococcus gram neg (NOT psuedomonas or acinetobacter) |
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clinical uses of ertapenem
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coverage of community acquired infections such as sssi, pneumonia, intraabdominal infections
|
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which has better for pseudomonas
dor imi mero |
doro>mero>imi
|
|
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doro used to tx
|
intraabdominal infections
uti hap |
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which carba can cause seizures
|
imipenem
|
|
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aztreonam stable in presence of most beta lactamases, but susceptible to --- and ---
|
amp c
ESBL |
|
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aztreonam used to tx
|
gram negatives only including pseudomonas
|
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clinical use of aztreonam
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empiric coverage and pathogen directed coverage of susceptible organisms in pcn allergic patients
|
|
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anti pseudomonal fluro
|
cipro
levo ofloxacin |
|
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anti-streptococcal fluro
|
levo
moxifloxacin |
|
|
cipro and ofloxacin spectrum
|
gram neg
including pseudomonas min gram pos coverage |
|
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t/f
cipro and ofloxacin can be used for amp c or esbl organisms |
t
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clinical use of cipro and ofloxacin
|
pseudomonal coverage as monotx for uti or as part of double coverage system for systemic infections
empiric cover for intraabdominal/nosocomial pneumonia/ complicated ssti's |
|
|
spectrum for levofloxacin and moxifloxacin
|
streptococcus pneumonia including prsp
some coverage of staph gram neg coverage atypical |
|
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only an fluro w/ anaerobe coverage
|
moxifloxacin
|
|
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clinical use of levo/moxi
|
CAP including prsp
levo may be used similar to cipro |
|
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fluoro will interact w/ --- or --- cations
|
divalent
trivalent |
|
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spectrum for aminoglycosides
|
aerobic gram neg
synergy w/ entercoccus and staphylococcus if given w/ a cell wall. . . gent only |
|
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clinical use of aminoglycosides
|
given in combo w/ beta-lactams to tx gram neg organisms, esp pseudomonas
|
|
|
which is amino best used for pseudomonas
tobra genta amikacin |
tobra>amikacin>gentamicin
|
|
|
--- is given in combo w/ ampicillin or vanco to treat enterococcus and staph
|
gentamycin
|
|
|
amionoglycosides are orally given to --- --- prior to sx
|
decontaminate bowel
|
|
|
spectrum of macrolides
|
s pneumoniae (poor coverage against PRSP)
Staph H flu m catarrhalis m pneumoniae c pneumoniae n gonorrhea c trachomatis h pylori legionella |
|
|
clinical uses of macrolides
|
upper resp infections
mild moder cap std's m avium legionella pneumoniae h pylori alt choice ssti |
|
|
major se of macrolides
|
GI intolerance
|
|
|
which has more di w/ cyp
erythromycin or clarithromycin |
erythromycin
|
|
|
spectrum of ketolide:
|
s pneumoniae (incluiding PRSP and macrolide resistant strep
better coverage against staph h flu mycoplasma chlamydia legionella |
|
|
clinical use of ketolide
|
urti
mild CAP |
|
|
ae of ketolides
|
gi intolerance
liver damage |
|
|
ex of ketolide
|
telithromycin
|
|
|
t/f
tetracycline: good tx for PRSP |
f
usu resistant to tetracyclines |
|
|
spectrum of tetracyclines:
|
gram pos staph
strep MRSA H flu atypical bacter (mycoplasma, chlamydia) |
|
|
odd uses of tetracyclines
|
acne
vibrio lyme disease rickettsiae |
|
|
glycylcycline: tigecycline
spectrum |
s aureus (MRSA)
s peneumoniae including (PRSP) gra neg including AMP C ESBL producing enterobacteriaceae |
|
|
clinical use of glycylcycline: tigecycline
|
pathogen directed tx of highly resistant bacgeria usu when other options are resistant such as amp c producing enterobacter, esbl, klebsiella, e coli
|
|
|
tmp/smx spectrum:
|
s aureus including mrsa
s pneumoniae (PRSP resistant) h flu m catarrhalis e coli proteus mirabilis k pneumoniae salmonella shigella pcp |
|
|
doc for pcp prophylaxis and tx
|
tmp/smx
|
|
|
what's used to tx stenotrophomonas maltophlia
|
tmp/smx
|
|
|
clinical uses of tmp/smx
|
uti
aecb infectious diarrhea ssti secondary to mrsa |
|
|
what test must be performed if eryhtromycin is resistant, so the activity of clindamycin can be determined
|
D test
|
|
|
spectrum of lincosamides: clindamycin
|
gram positives (including mrsa)
mouth anaerobes b fragilis |
|
|
lincosamides usu given w/ an agent that covers
|
gram neg
|
|
|
clinical use of lincosamide
|
mouth infections
gram pos ssti anaerobic resp infections given w/ gram neg agent to tx polymicrobial dm foot and decubitus ulcer infection |
|
|
t/f
lincosamides can cause c diff diarrhea |
t
|
|
|
lincosamides can cause n/v w/ -- formulation
|
oral
|
|
|
glycopeptide-vanco spectrum
|
staphlycoccus spp including mrsa
enterococcus streptococcus (including prsp) c diff |
|
|
doc for mrsa infections
|
vanco
|
|
|
clinical use of vanco
|
c diff (oral only)
enterococcus faecalis |
|
|
--- levels determined by location of infection
|
trough
|
|
|
t/f
redman is an allergy |
f
give w/ antihistamine |
|
|
oxazolidinone - linezolid bacteriastatic against :
bateriocidal against |
static: staph and enterococci
cidal: strep |
|
|
oxazolidinone - linezolid spectrum
|
gram pos only including mrsa, prsp, vre covers both e faecalis adn e faecium
|
|
|
t/f
oxazolidinone - linezolid active against gram neg or anaerobic organism |
f
|
|
|
clinical uses of oxazolidinone - linezolid
|
mrsa pneumonia and ssti
endocarditis meningitis tx vre can be given orally for mrsa and vre |
|
|
linezolids ci w/
|
ssris
snris maois |
|
|
route of daptomycin
|
iv
|
|
|
lipopeptide: daptomycin spectrum
|
gram positive:
s aureus including mrsa e faecalis e facium including vre |
|
|
why can't you use daptomycin in pneumonia?
|
inactivated by surfactant
|
|
|
telavancin used for
|
gram pos including mrsa, prsp, and some vre
|
|
|
streptogramins: quinupristin/dalfopristin spectrum
|
gram pos s aureus including mrsa
enterococcus pneumoniae incluidng prsp |
|
|
streptogramins: quinuprisitn/dalfoprisitin not active against:
|
enterococcus faecalis
|
|
|
doc for c diff
|
metronidazole
|
|
|
metronidazole used against
|
gram neg anaerobes including bacteroides fragilis and clostridium spp, spirochetes, campylobater, gardenerella vaginialis, h pylori
|
|
|
used in b fragilis and bacterial vaginosis
|
metronidazole
|
|
|
this med causes a disulfiram like rxn
|
metronidazole
|
|
|
metronidazole will prolong -----
|
INR
di w/ warfarin |
|
|
rifamipin used agains
|
stapylococcus sp
streptococcus sp h flu neisseria listeria b fragilis clostridium mycobacterium tb |
|
|
clinical use of rifampin
|
tb
|
|
|
colistin/polymixin spectrum:
|
gram neg:
e coli p aeruginosa enterobacter salmonella shigella |
|
|
clinical use of colistin/polymixin
|
resistant gram neg
|
