thera II test III infectious disease

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thera II test III infectious disease
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2013-05-06 19:32:53
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thera II test III infectious disease
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  1. the quntitative ability of an organism to cause disease
    virulence
  2. 3 virulance factors
    • adherence
    • invasion
    • toxigenicity
  3. indirect contact route of transmission 2
    • clostridium difficile
    • contaminated medical supplies
  4. respiratory droplet transmission 3
    • > 5microm in size
    • transmissible < 6 feet
    • influenza
  5. airborne transmission 3
    • < 5 micorm in size
    • transmissible over long distance
    • mycobacterium tuberculosis
  6. water or food-borne route of transmission 2
    • often fecal-oral
    • escherichia coli
  7. environmental route of tranmission 2
    • pathogen ubiquitous in environments
    • aspergillus sp. (fungi,mold, yeast)
  8. 3 key pathogen gram positive bacteria groups
    • staphylococcus
    • streptococcus
    • enterococcus
  9. 3 key pathogen gram negative bacteria
    • cocci
    • bacilli (rods)
    • coccobacilli
  10. 3 gram negative cocci
    • neisseria meningitidis
    • N. gonorrhoeae
    • moraxella catarrhalis
  11. 1 gram negative coccobacilli
    heamophilus influenzae
  12. 3 gram-negative bacilli (rods) GNRs
    • enterobactericiae
    • E. coli
    • Klebsiella
  13. 3 key pathogen fungi
    • caidida species
    • apsergillus species
    • blastomyces dermitiditis
  14. 4 steps process to using antimicrobial agents appropriately
    • confirm presence of infection
    • identification of the pathogen
    • selection of empiric therapy
    • monitoring therapeutic response
  15. 3 (non-test) ways to confirm the presence of an infection
    • history and physical
    • signs and symptoms
    • predisposing factors
  16. 3 S&S of infection
    • fever - not very specific
    • white blood cell count
    • local signs
  17. which method of confirming the presence of infection can be the most specific
    local signs
  18. elevated in bacterial infection
    • neutrophils (50-70%)
    • also band forms
  19. elevated in viral, TB or fungal infection
    lymphocytes
  20. increased in TB or lymphoma
    monocytes
  21. increased in allergic reactions or parasitic infection
    eosinophils
  22. methods for obtaining blood cultures when pt spikes fevers
    • 2 sets
    • 1 hour apart
    • different sites
    • each set consists of 1 aerobic and 1 anaerobic bottle
  23. initiation of treatment prior to determination of a firm diagnosis
    empiric therapy
  24. therapy with a culture test to identify the bug and sensitivities
    definitive therapy
  25. 3 concomitant medications for antimicrobials
    • fluoroquinolones or bactrim + warfarin = doubled INR
    • metronidazole + alcohol
    • AGs or FQs + multivaltent cations (milk) = chelation
  26. what is the suseptiblilty ratio you are looking for on the antibiogram
    >90%
  27. 4 drug factors when picking a therapy
    • spectrum of activity
    • pharmacokinetics
    • toxicity % monitoring
    • cost
  28. 2 toxicities present with almost all antimicrobials
    • photosensitivity
    • diarrhea
  29. 4 cases when you might need combination therapy for broad spectrum of coverage due to mixed infections from mulitple organisms
    • intr-abdominal
    • felmale pelvic infections
    • diabetic foot infections
    • nosocomial/ healthcare - acquired
  30. 6 drugs with 100% bioavailabilty for IV to PO switch
    • Doxycycline
    • Linezolid
    • Fluoroquinolones
    • TMP/SMX
    • Metronidazole
    • Fluconazole
  31. what does a coagulase test differentiate
    staphylococcus species
  32. what is a coagulase (+)
    staph aureus
  33. what is coagulase (-)
    staph epidermidis
  34. what is blood agar used to differentiate
    hemolytic properties
  35. a-hemolytic designates
    • partial hemolysis
    • green color
    • strep pneumonia or strep viridians
  36. b-hemolytic represents
    • complete hemolysis
    • clear
    • strep pyogenes - group A or B
  37. gamma hemolytic represents
    • no hemolysis
    • enterococcus
  38. if D-test shows inducible resistance what don't you use
    clindamycin
  39. lactose non-fermenter bacteria
    pseudomonas aeruginosa
  40. lactose fermenter bacteria
    • E. Coli
    • klebsiella sp
    • enterobacter sp
  41. if you had conflicting results from a sensitivity test and an antibiogram, which one would you go off of
    sensitivity most of the time
  42. an example of a bug that is intrinsically resistant to a drug
    e.coli to vancomycin
  43. an example of a bug that has acquired resistance
    MRSA & VRE
  44. 4 mechanisms of bug resistance
    • target site alteration
    • drug inactivation
    • target inaccessibility
    • metabolic by-pass
  45. 2 primary methods for antimicrobial susceptibility testing
    • qualitative
    • quantitative
  46. lowest antimicrobial concentration that prevents visible growth of an organism after approximately 24 hrs of incubation in a specified growth medium
    minimal inhibitory concentration
  47. MIC cut-off values that signify a bacterial population as sensitive, intermediate or resistant
    breakpoints
  48. lowest drug concentration that kills 99.9% of an inoculum
    minimal bactericidal concentration
  49. what does it mean when the MBC exceeds the MIC by > 32 times
    the organism is considered tolerant to the antibiotic
  50. which 10 drugs cover MRSA
    • vancomycin
    • clindamycin
    • daptomycin
    • doxycycline
    • minocycline
    • tigercycline
    • linezolid
    • ceftaroline
    • quinpristin/dalfoprisitin - synercid
    • bactrim
  51. which antimicrobial don't you use for pneumonia
    daptomycin
  52. which antimicrobial don't  you use for UTI
    moxafloxacillin
  53. which antimicrobial don't you use for P. aeruginosa
    piperacillin/tazobactam
  54. which drugs cover pseudomonas 9
    • 3rd gen cephalosporins
    •   ceftazidime
    •   cefepime
    • carbapenem
    •   meropenem
    •   imipenem
    •   doripenem
    • monobactam
    •   aztreonam
    • fluoroquinolone
    •   levofloxacin
    •   ciprofloxacin
    • aminoglycosides w/ another agent
  55. what is the drug of choice of extended-spectrum b-lactamases (ESBLs)
    carbapenem
  56. Tx option for carapenem resistance
    • tigecycline
    • colistin
  57. 2 time-dependent antibiotic groups
    • b-lactams
    • macrolides
  58. 4 concentration-dependent antibiotics
    • aminoglycosides
    • fluoroquinolones
    • metronidazole
    • daptomycin
  59. 5 pharmacist's role with antibiotics
    • describe the mechanism of antibiotic resistance
    • identifiy possibl pathogens based on gram stain and initial culture data
    • recommend appropriate empiric therapy for these organisms using an antibiogram
    • use a culture and sensitivity report to recommend definitive therapy
    • recognize situaitons where knowing the MICs is essential to providing the best antibiotic coverage
  60. 1 gram (-) coccobacilli
    H. influenza

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