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65 Cards in this Set
- Front
- Back
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Meningitis |
CAUSE: Gram-positive & Gram-negative S/Sx: fever, headache, photophobia, nuchal rigidity, seizures, vomiting TREAT: >1 month: vanco + cefotaxime or ceftriaxone |
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Meningitis: newborn to 1 months |
1. S. agalactiae 2. E coli 3. Listeria 4. Klebsiella TREAT: ampicillin + cefotaxime or aminoglycoside |
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Meningitis: 1-23 months |
1. S pneumonia & S agalactiae 2. Neisseria 3. Haemophilus influenzae 4. E coli TREAT: Vanco + ceftriaxone or cefotaxime |
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Meningitis: 2-50 yrs |
1. Neisseria 2. S pneumoniae TREAT: Vanco + ceftriaxone or cefotaxime |
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Meningitis: >50yrs |
1. S pneumonia 2. Neisseria 3. Listeria 4. aerobic GNB TREAT: Vanco + ampicillin + ceftriaxone or cefotaxime |
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Endocarditis |
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 |
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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 |
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Febrile Neutropenia |
CAUSE: Coag-neg Staph, Staph aureus, Entero, Strep pneumoniae & pyogenes, E coli, pseudomonas, Klebsiella, Enterobacter S/Sx: low WBC, fever, severe pneumonia TREAT: Low risk: oral cipro + augmentin High Risk: cefepime, zosyn, carbapenem |
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Acute or Chronic Bronchitis |
CAUSE: mycoplasma, Chlamydophila, Bordetella, Strep pneumoniae, Moraxella, Haemophilus S/Sx: productive or nonproductive cough, fever, muscle aches, fatigue TREAT: Acute: none Acute by pertussis: macrolide Exacerbation: amox, augmentin, macrolide, doxy, minocycline |
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Pneumonia (CAP) |
CAUSE: Strep pneumoniae, Mycoplasma, Haemophilus, Legionella TREAT: macrolide, doxy, resp fluoroquinolone |
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Pneumonia (HAP, VAP) |
CAUSE: Strep pneumoniae, Haemophilus, MSSA, E coli, Klebsiella, Enterobacter, proteus, Pseudomonas, MRSA TREAT: ceftriaxone, fluoroquinolone, unasyn, vanco, antipseudomonal |
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Tuberculosis |
Cause: mycobacterium TREAT: isoniazid, rifampin, pyrazinamide, ethambutol |
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Intra-Abdominal Infections |
CAUSE: E.coli, Bacteroides TREAT: metronidazole, cephalosporin, carbapenem, flouoroquinolone |
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Aminoglycosides |
1. gentamicin
2. tobramycin 3. amikacin 4. streptomycin |
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Aminoglycosides |
MOA: inhibit bacterial protein synthesis through binding to 30S subunit **BACTERICIDAL** ADRs: nephrotoxicity (pharmacokinetic dosing), ototoxicity |
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Coverage of Amikacin |
broadest coverage of the aminoglycosides covers bacteria resistant to other aminoglycosides |
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Coverage of 1) gentamicin 2) tobramycin 3) streptomycin |
1) acinetobacter, Serratia, enterococci 2) pseudomonas 3) enterococci, strep, mycobacteria, some GN anaerobes |
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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 |
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Penicillins |
MOA: binds to PBPs and inhibits cell wall synthesis - cell wall lysis = death **bactericidal** ADRs: allergy, rash, seizures(high doses), GI effects COVER: Gram Positives |
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Cephalosporins |
MOA: bind to PBPs and inhibit peptidoglycan synthesis = cell wall lysis = death
**bactericidal** ADRs: hypersensitivity, GI effects, seizures(high dose), nephrotoxicity(rare) |
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First Generation Cephalosporins |
cefadroxil, cefazolin, cephalexin --Extensive gram positive coverage --inactive against MRSA & MRSE --limited Gram negative |
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2nd Generation Cephalosporins |
cefaclor, cefotetan, cefoxitn, cefprozil, cefuroxine, cefoxitin --Extensive gram positive coverage --some gram negative cover --NO pseudomonas coverage |
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3rd generation Cephalosporins |
cefdinir, cefixime, cefotaxime, cefpodoxime, ceftazidime, ceftibuten, ceftriaxone --reduced gram positive activity --extensive gram negative coverage |
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4th generation Cephalosporin |
cefepime --good gram positive coverage --extensive gram negative coverage --covers pseudomonas & enterobacteriaceae --inactive against MRSA, listeria, anaerobes |
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3rd generation that covers pseudomonas |
ceftazidime |
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Cabapenems |
imipenem-cilastatin, doripenem, meropenem, ertapenem, aztreonam MOA: bind PBPs which inhibit peptidoglycan synthesis = cell wall lysis = death **bactericidal** ADRs: GI effects, seizures(rare), leukopenia |
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Carbapenem that can be used in anaphylactic beta-lactam allergy |
aztreonam |
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Carbapenem that doesn't cover pseudomonas |
ertapenem |
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Linezolid (Zyvox) |
MOA: binds to 23S site of 50S ribosomal subunit = inhibits bacterial translation & protein synthesis **bacteriostatic** COVER: Staph, MRSA, enterococcus, VRE, strep |
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Quinupristin-Dalfopristin (Synercid) |
MOA: inhibits late-phase protein synthesis COVER: staph, MRSA, strep, enterococcus, VRE *not active again E faecalis |
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Daptomycin (Cubicin) |
MOA: binds to bacterial cell membranes - rapid depolarization - loss of membrane potential = cell death COVER: staph, MRSA, strep, enterococci, VRE |
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Vancomycin (vancocin) |
MOA: exhibit bactericidal killing through inhibiting peptidoglycan synthesis = cell wall synthesis inhibition COVER: staph, MRSA, strep, enterococci, C diff` |
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FLuoroquinolones |
ciprofloxacin, levofloxacin, moxifloxacin, ofloxacin MOA: bactericidal - inhibits topo II and topo IV = disrupts DNA replication COVER: extensive gram negative coverage, legionella |
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fluoroquinolones that have excellent gram positive coverage |
levofloxacin, moxifloxacin |
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fluoroquinolone with anaerobic coverag |
moxifloxacin |
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Macrolides |
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 |
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Macrolide used to accelerate gastric emptying |
erythromycin |
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Tetracyclines |
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 |
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Tigecycline |
glycylcycline that covers MRSA, VRE, and anaerobes but doesn't cover Pseudomonas |
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Sulfonamides |
sulfamethoxazole, sulfadiazine MOA: interfere with bacterial folic acid synthesis by inhibiting PABA **bacteriostatic** COVER: gram positive, MSSA, community-acquired MRSA, gram negatives, toxoplasma, plasmodium |
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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 |
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Metronidazole |
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 |
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Polymyxins |
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 |
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Rifaximin |
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 |
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fidaxomicin |
MOA: inhibits bacterial RNA polymerase COVER: in vitro against Clostridium (C diff) ADRs: N/V, pain, bleeding |
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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 |
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Echinocandins |
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 |
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Azole Antifungals |
MOA: inhibit fungal CYP450 14-alpha-demethylase = decrease ergosterol concentrations 1. Fluconazole 2. Itraconazole 3. Ketoconazole 4. Voriconazole 5. Posaconazole |
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Fluconazole (Diflucan) |
Drug of Choice: candida albicans COVER: cryptococcus, coccidioides Resistant - candida krusei ADRs: N/V/D, ab pain, cholestasis, increased LFTs, hemolytic effects |
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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 |
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Ketoconazole (Nizoral) |
No longer recommended for systemic use = significant hepatotoxicity & adrenal insufficiency |
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Voriconazole (Vfend) |
Drug of Choice: aspergillosis COVER: non-C albicans species, histoplasma, blastomyces ADRs: hepatic effects, visual disturbances, hallucinations, skin reactions |
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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 |
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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 |
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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 |
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Nystatin |
MOA: binds to fungal sterols COVER: cutaneous & mucocutaneous candidiasis ADRs: mild N/D |
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Terbinafine (Lamisil) |
MOA: interferes with sterol biosynthesis COVER: trichophyton, microsporum, epidermophyton, yeasts ADRs: hepatic effects, skin sensitivities |
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Rifampin |
MOA: inhibits RNA synthesis COVER: mycobacterium, Gram positive & gram negatives ADRs: N/V/D, ab pain, headache, dizziness, hepatic effects **can discolor body fluids** |
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Isoniazid |
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 |
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Pyrazinamide |
MOA: converted to pyrazinoic acid by mycobacterium tuburculosis COVER: mycobacterium tuberculosis only ADRs: increased LFTs, pain, gout |
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Ethambutol |
MOA: inhibits bacterial cellular metabolism (bacteriostatic) COVER: mycobacterium ADRs: ocular effects, peripheral neuropathy |
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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 |
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Capreomycin (Capastat) |
MOA: unknown - bacteriostatic COVER: mycobacterium ADRs: nephrotoxicity, ototoxicity *avoid in pregnancy |
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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 |
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Ethionamide |
MOA: inhibits cell wall synthesis - exact unknown COVER: mycobacterium ADRs: GI effecvts, metallic taste, peripheral and optic neuritis |
