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65 Cards in this Set

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CAUSE: Gram-positive & Gram-negative

S/Sx: fever, headache, photophobia, nuchal rigidity, seizures, vomiting


>1 month: vanco + cefotaxime or ceftriaxone

Meningitis: newborn to 1 months

1. S. agalactiae

2. E coli

3. Listeria

4. Klebsiella

TREAT: ampicillin + cefotaxime or aminoglycoside

Meningitis: 1-23 months

1. S pneumonia & S agalactiae

2. Neisseria

3. Haemophilus influenzae

4. E coli

TREAT: Vanco + ceftriaxone or cefotaxime

Meningitis: 2-50 yrs

1. Neisseria

2. S pneumoniae

TREAT: Vanco + ceftriaxone or cefotaxime

Meningitis: >50yrs

1. S pneumonia

2. Neisseria

3. Listeria

4. aerobic GNB

TREAT: Vanco + ampicillin + ceftriaxone or cefotaxime


CAUSE: fungi or bacteria - Strep, Staph, Entero

S/Sx: low-grade fever, fatigue, weakness, new heart murmur, petechiae

TREAT: PCN G, Ceftriaxone, Gentamicin, Vanco, Ampicillin, Nafcillin

Central-Line Associated BloodStream Infections

CAUSE: Staph aureus & Coag-neg Staph, candida, Entero, Pseudomonas

S/Sx: fever or hypothermia, chills, tachycardia, tachypnea, up or down WBC

TREAT: Vanco, Nafcillin/oxacillin, cefepime

Febrile Neutropenia

CAUSE: Coag-neg Staph, Staph aureus, Entero, Strep pneumoniae & pyogenes, E coli, pseudomonas, Klebsiella, Enterobacter

S/Sx: low WBC, fever, severe pneumonia


Low risk: oral cipro + augmentin

High Risk: cefepime, zosyn, carbapenem

Acute or Chronic Bronchitis

CAUSE: mycoplasma, Chlamydophila, Bordetella, Strep pneumoniae, Moraxella, Haemophilus

S/Sx: productive or nonproductive cough, fever, muscle aches, fatigue


Acute: none

Acute by pertussis: macrolide

Exacerbation: amox, augmentin, macrolide, doxy, minocycline

Pneumonia (CAP)

CAUSE: Strep pneumoniae, Mycoplasma, Haemophilus, Legionella

TREAT: macrolide, doxy, resp fluoroquinolone

Pneumonia (HAP, VAP)

CAUSE: Strep pneumoniae, Haemophilus, MSSA, E coli, Klebsiella, Enterobacter, proteus, Pseudomonas, MRSA

TREAT: ceftriaxone, fluoroquinolone, unasyn, vanco, antipseudomonal


Cause: mycobacterium

TREAT: isoniazid, rifampin, pyrazinamide, ethambutol

Intra-Abdominal Infections

CAUSE: E.coli, Bacteroides

TREAT: metronidazole, cephalosporin, carbapenem, flouoroquinolone


1. gentamicin

2. tobramycin

3. amikacin

4. streptomycin


MOA: inhibit bacterial protein synthesis through binding to 30S subunit


ADRs: nephrotoxicity (pharmacokinetic dosing), ototoxicity

Coverage of Amikacin

broadest coverage of the aminoglycosides

covers bacteria resistant to other aminoglycosides

Coverage of

1) gentamicin

2) tobramycin

3) streptomycin

1) acinetobacter, Serratia, enterococci

2) pseudomonas

3) enterococci, strep, mycobacteria, some GN anaerobes

Preferred drug levels of

1) amikacin

2) tobra and gen

1) peak: 20-30 mcg/mL trough: <8-10

2) peak: 3-10 trough: 1-2


MOA: binds to PBPs and inhibits cell wall synthesis - cell wall lysis = death


ADRs: allergy, rash, seizures(high doses), GI effects

COVER: Gram Positives


MOA: bind to PBPs and inhibit peptidoglycan synthesis = cell wall lysis = death


ADRs: hypersensitivity, GI effects, seizures(high dose), nephrotoxicity(rare)

First Generation Cephalosporins

cefadroxil, cefazolin, cephalexin

--Extensive gram positive coverage

--inactive against MRSA & MRSE

--limited Gram negative

2nd Generation Cephalosporins

cefaclor, cefotetan, cefoxitn, cefprozil, cefuroxine, cefoxitin

--Extensive gram positive coverage

--some gram negative cover

--NO pseudomonas coverage

3rd generation Cephalosporins

cefdinir, cefixime, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftriaxone

--reduced gram positive activity

--extensive gram negative coverage

4th generation Cephalosporin


--good gram positive coverage

--extensive gram negative coverage

--covers pseudomonas & enterobacteriaceae

--inactive against MRSA, listeria, anaerobes

3rd generation that covers pseudomonas



imipenem-cilastatin, doripenem, meropenem, ertapenem, aztreonam

MOA: bind PBPs which inhibit peptidoglycan synthesis = cell wall lysis = death


ADRs: GI effects, seizures(rare), leukopenia

Carbapenem that can be used in anaphylactic beta-lactam allergy


Carbapenem that doesn't cover pseudomonas


Linezolid (Zyvox)

MOA: binds to 23S site of 50S ribosomal subunit = inhibits bacterial translation & protein synthesis


COVER: Staph, MRSA, enterococcus, VRE, strep

Quinupristin-Dalfopristin (Synercid)

MOA: inhibits late-phase protein synthesis

COVER: staph, MRSA, strep, enterococcus, VRE

*not active again E faecalis

Daptomycin (Cubicin)

MOA: binds to bacterial cell membranes - rapid depolarization - loss of membrane potential = cell death

COVER: staph, MRSA, strep, enterococci, VRE

Vancomycin (vancocin)

MOA: exhibit bactericidal killing through inhibiting peptidoglycan synthesis = cell wall synthesis inhibition

COVER: staph, MRSA, strep, enterococci, C diff`


ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin

MOA: bactericidal - inhibits topo II and topo IV = disrupts DNA replication

COVER: extensive gram negative coverage, legionella

fluoroquinolones that have excellent gram positive coverage

levofloxacin, moxifloxacin

fluoroquinolone with anaerobic coverag



azithromycin, clarithromycin, erythromycin

MOA: bacteriostatic by binding to 50s ribosomal subunit = inhibit RNA synthesis

COVER: gram positives, chlamydia, mycoplasma, spirochetes,mycobacteria

**DOC in atypical pneumonia & Chlamydia

Macrolide used to accelerate gastric emptying



doxycycline, minocycline, tetracycline, tigecycline

MOA: bacteriostatic - inhibit protein synthesis by binding to 30s ribosomal subunit

COVER: mycoplasma, chlaymdia, legionella, Borrelia, Rickettsia, Pasteurella, Yersinia, Plasmodium, MRSA


glycylcycline that covers MRSA, VRE, and anaerobes but doesn't cover Pseudomonas


sulfamethoxazole, sulfadiazine

MOA: interfere with bacterial folic acid synthesis by inhibiting PABA **bacteriostatic**

COVER: gram positive, MSSA, community-acquired MRSA, gram negatives, toxoplasma, plasmodium

Clindamycin (Cleocin)

MOA: inhibits 50S ribosomal subunit inhibiting RNA synthesis **bacteriostatic**

COVER: gram-positive, some anerobic gram negatives, community-acquired MRSA

*NO coverage against aerobic gram negative*

ADRS: N/V/D, ab pain


MOA: inhibits DNA synthesis

COVER: bacteroides, anerobic gram negatives and positives, protozoa, h pylori, peptococcus, peptostrepto, trich, giardia

ADRs: taste issues, N/V, ab discomfort, dizzines, headache


polymyxin B and colistin

MOA: bactericidal that act as anionic detergents that damage the external cell membrane = death

COVER: aerobic gram-negative bacilli

ADRs: nephrotoxicity and neurotoxicity


MOA: inhibits beta-subunit of DNA-dependent RNA-polymerase = inhibit RNA synthesis

COVER: gram-negative enteric in GI tract

ADRs: peripheral edema, nausea, dizziness, fatigue, ascites, flatulence, headache


MOA: inhibits bacterial RNA polymerase

COVER: in vitro against Clostridium (C diff)

ADRs: N/V, pain, bleeding

Amphotericin B

MOA: binds to ergosterol in the fungal cell wall leading to increased permeability = cell death

COVER: aspergillus, cryptococcus, histoplasma, candida

ADR: infusion reactions, nephrotoxicity (DLT), hematologic effects


caspofungin, micafungin,anidulafungin

MOA: inhibit beta-(1,3) glucan synthase - cannot form fungal cell wall = death

COVER: Candida albicans (DOC), candida, aspergillus

ADRs: increased LFTs, sensitivity, infusion reactions

Azole Antifungals

MOA: inhibit fungal CYP450 14-alpha-demethylase = decrease ergosterol concentrations

1. Fluconazole

2. Itraconazole

3. Ketoconazole

4. Voriconazole

5. Posaconazole

Fluconazole (Diflucan)

Drug of Choice: candida albicans

COVER: cryptococcus, coccidioides

Resistant - candida krusei

ADRs: N/V/D, ab pain, cholestasis, increased LFTs, hemolytic effects

Itraconazole (Sporanox)

USE: Histoplasma, Blastomyces

COVER: candida, aspergillus, some cryptococcus

ADRs: N/V/D, ab pain, dyspepsia, gastritis, skin issues, headache, dizziness, CHF, prolonged QT

Ketoconazole (Nizoral)

No longer recommended for systemic use = significant hepatotoxicity & adrenal insufficiency

Voriconazole (Vfend)

Drug of Choice: aspergillosis

COVER: non-C albicans species, histoplasma, blastomyces

ADRs: hepatic effects, visual disturbances, hallucinations, skin reactions

Posaconazole (Noxafil)

Primary: prophylaxis of invasive fungal infections in the immunocompromised

COVER: aspergillus, candida, zygomycetes

*also used for esophageal candidiasis

ADRs: N/V/D, ab pain, rash/pruritis, headache, dizziness, QT prolongation, increased LFTs

Flucytosine (Ancobon)

MOA: converted to 5-FU inside fungal cell causing cell death

COVER: cryptococcus, candida

*combine with amphotericin B for cryptococcal meningitis

ADRs: GI hemorrhage, ulcerative colitis, N/V/D, increased SCr & BUN, confusion, hallucinations

Griseofulvin (Fulvicin P/G)

MOA: disrupts fungal cells' mitotic spindle structure = inhibits metaphase

COVER: tricophyton, microsporum, epidermophyton

*no candida

ADRs: headache, fatigue, dizziness, N/V/D, proteinuria, rash


MOA: binds to fungal sterols

COVER: cutaneous & mucocutaneous candidiasis

ADRs: mild N/D

Terbinafine (Lamisil)

MOA: interferes with sterol biosynthesis

COVER: trichophyton, microsporum, epidermophyton, yeasts

ADRs: hepatic effects, skin sensitivities


MOA: inhibits RNA synthesis

COVER: mycobacterium, Gram positive & gram negatives

ADRs: N/V/D, ab pain, headache, dizziness, hepatic effects

**can discolor body fluids**


MOA: inhibits bacterial cell wall (only effective in actively dividing cells

COVER: mycobacterium

ADRs: peripheral neuropathy, increased LFTs & Bili, agranulocytosis

*DOC of latent TB (monotherapy for 9 months)

*supplement with pyridoxine 25mg daily


MOA: converted to pyrazinoic acid by mycobacterium tuburculosis

COVER: mycobacterium tuberculosis only

ADRs: increased LFTs, pain, gout


MOA: inhibits bacterial cellular metabolism (bacteriostatic)

COVER: mycobacterium

ADRs: ocular effects, peripheral neuropathy

Aminosalicyclic acid

MOA: inhibits folic acid synthesis in a manner similar to that of sulonamides (bacteriostatic)

COVER: mycobacterium tuberculosis only

ADRs: severe N/V/D, ab pain, vitamin B12 & folic acid & iron malabsorption, fever, joint pain, endocrin issues

Capreomycin (Capastat)

MOA: unknown - bacteriostatic

COVER: mycobacterium

ADRs: nephrotoxicity, ototoxicity

*avoid in pregnancy

Cycloserine (Seromycin)

MOA: inhibits cell wall synthesis by competing for incorporation into bacterial cell wall

COVER: mycobacterium

ADRs: headache, vertigo, confusion, psychosis

*use with high-dose pyridoxine


MOA: inhibits cell wall synthesis - exact unknown

COVER: mycobacterium

ADRs: GI effecvts, metallic taste, peripheral and optic neuritis