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mousie77
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ID 1
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2013-01-23 22:21:40
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  1. Are sulfonamides cidal or static?
    static
  2. Sulfonamide MOA
    Antimetabolite of PABA. Prevents DNA synthesis by competitive inhibition of dihydropterate synthetase.
  3. Collateral damage
    Overgrowth of pathogenic flora due to antibiotic use. AKA superinfection
  4. How is infection treated?
    • 1. Immune system activation
    • 2. Drainage
    • 3. Antimicrobials

    MUST HAVE ALL 3!
  5. Emperic therapy
    Broad spectrum ABX
  6. Definitive therapy
    • streamlining or de-escalation.
    • specific ABX due to culture results
    • use most narrow spectrum
  7. Gram + color
    purple
  8. Gram - color
    red
  9. Endogenous infections...
    Arise from our own flora due to overgrowth or disruption of host defenses
  10. Sterile sites in body:
    • CSF
    • blood
    • urine
  11. Fever is defined as:
    > 100.9
  12. Why can't ESR and CRP be used to diagnose infection?
    They are nonspecific inflammatory markers
  13. What is the "breakpoint?"
    The [ ] of antimicrobial that can be achieved in the serum after a standard dose.
  14. If MIC > breakpoint then...
    The organism is resistant.
  15. Source control
    Removal of prosthetic materials, infected tissue, draining of wounds and getting rid of potential bacterial sources
  16. Concentration dependent killing and examples
    • Higher [ ] is associated with higher kill rates
    • Ex: Floroquinolones, AG's, Metronidazole.
    • ODD
  17. Time dependent killing and examples
    • ABX is most efficacious when [ ] is held above MIC for a certain period of time.
    • Continuous infusion.
    • Ex: Beta-lactams
  18. What causes crystalluria with sulfonamides?
    How can we prevent it?
    • Caused by high pka
    • Prevent by:
    • ----heterocyclic rings to decrease pka
    • ----triple sulfa
    • ----alkalize urine pH
    • ----drink lots of water
  19. Trimethoprim MOA
    • Inhibits dihydrofolate reductase
    • No folic acid, no DNA
  20. TMP-SMX
    • Sequential blockade
    • Decreases resistance
    • 1:5 ratio
    • NO NEONATES
  21. Dapsones
    • MOA is same as sulfa drugs
    • It is a SULFONE
    • Leprosy
  22. Flouroquinolones MOA
    • Inhibits DNA gyrase and topoisomerase IV
    • No DNA synthesis.
    • NO CHILDREN < 18 (except with CF)
    • ODD
    • No divalent ions!
  23. Levofloxacin
    • Quinolone
    • L-isomer of ofloxacin
    • Inhibits DNA gyrase and topoisomerase IV
    • Bactericidal
    • Pneumonia
    • No divalent ions!
  24. Quinolones: cidal or static?
    cidal
  25. Ciprofloxacin
    • Quinolone
    • 1st line for Pseudomonas
    • No divalent ions! (C-6)
    • Inhibits DNA gyrase and topoisomerase IV
  26. Nitrofurantoin MOA
    • Inhibits acetylcoenzyme A
    • NO2 reduced to NH2 causing DNA damage
    • Prevents kidney stones
  27. Methenamine MOA
    • Degrades in bladder to formaldehyde and ammonia
    • Acidifies urine
    • Do not consume urinary alkalizers
  28. Tetracycline MOA
    • Inhibits protein synthesis at 30s by preventing binding of tRNA to A site
    • TERATOGENIC
    • Brown teeth
    • Catabolic
    • Bone deformation (no children)
  29. Tetracyclines: cidal or static
    cidal
  30. Tetracycline drug interactions
    phenytoin and barbs
  31. Tovan
    • Quinolone
    • Reserved for nosocomial and flesh eating bacteria. LAST RESORT
    • LIVER DAMAGE
  32. Why do tetracyclines have such a short shelf-life?
    • Epimerization to an inactive form via UV light
    • Dehydration to an anhydrous form when exposed to moisture
  33. What is Tygacil?
    • Tetracycline MOA
    • Extensive distribution in tissues
    • Glycylcine
  34. Macrolide MOA
    Binds 50s near the P site, inhibiting translocation and protein synthesis.
  35. Macrolides are cidal or static?
    • Both depending on:
    • ----concentration
    • ----susceptability
    • ----size of the inoculum
  36. Erythromycin
    • Macrolide
    • 1st line for Legionnares
    • Unstable in acid
    • Poorly water soluble, so must be in salt form
  37. Torleandomycin
    • Macrolide
    • Prodrug/triacyl derivative of oleanomycin. Hydrolyzed in vivo to active form.
    • Cross resistant with Erythromycin & less active.
  38. Beta-Lactamase
    • Targets the lactam ring
    • Deactivates antibiotic via suicide inhibition
  39. Penicillinase
    • Targets RCOHN- above the lactam ring
    • Large R groups prevent hydrolysis and make the ABX resistant

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