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65 Cards in this Set

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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

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

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

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




TREAT:


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




TREAT:


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

Tuberculosis

Cause: mycobacterium




TREAT: isoniazid, rifampin, pyrazinamide, ethambutol

Intra-Abdominal Infections

CAUSE: E.coli, Bacteroides




TREAT: metronidazole, cephalosporin, carbapenem, flouoroquinolone

Aminoglycosides

1. gentamicin

2. tobramycin


3. amikacin


4. streptomycin



Aminoglycosides

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




**BACTERICIDAL**




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

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

Cephalosporins

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



**bactericidal**




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

cefepime




--good gram positive coverage


--extensive gram negative coverage


--covers pseudomonas & enterobacteriaceae


--inactive against MRSA, listeria, anaerobes

3rd generation that covers pseudomonas

ceftazidime

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

Carbapenem that can be used in anaphylactic beta-lactam allergy

aztreonam

Carbapenem that doesn't cover pseudomonas

ertapenem

Linezolid (Zyvox)

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




**bacteriostatic**




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`

FLuoroquinolones

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

moxifloxacin

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

Macrolide used to accelerate gastric emptying

erythromycin

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

Tigecycline

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

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

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

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

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

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

fidaxomicin

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

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

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

Nystatin

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

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**

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

Pyrazinamide

MOA: converted to pyrazinoic acid by mycobacterium tuburculosis




COVER: mycobacterium tuberculosis only




ADRs: increased LFTs, pain, gout

Ethambutol

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

Ethionamide

MOA: inhibits cell wall synthesis - exact unknown




COVER: mycobacterium




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