Viral

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pcophung
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69724
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Viral
Updated:
2011-03-08 22:00:22
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Viral
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MOs & Abx
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  1. Staphylococcus Aureus
    Gram Positive Cocci

    • Clusters
    • -coag. positive

    diff. MSSA/MRSA
  2. Staphylococcus epidermidis
    Gram positive cocci

    • Clusters
    • -coag. negative

    diff. MSSA/MRSA
  3. Streptococcus

    (S. Pneumoniae, S. Pyogenes)
    Gram positive cocci

    Chains or pairs
  4. Enterococcus

    (E. faecalis, E. faecium)
    gram positive cocci

    chains or pairs

    diff. VRE
  5. Listeria meningitidis
    gram positive rod
  6. Neisseria species

    (N. meningitidis, N. gonorrhoeae)
    Gram negative cocci
  7. Moraxella catarrhalis
    Gram negative cocci

    respiratory pathogen
  8. Enterobacteriaceae

    (E. coli, enterobacter, klebsiella, proteus, serratia, citrobacter, salmonella, shigella)
    Gram negative rods/bacilli

    lactose fermenting
  9. Acinetobacter
    gram negative rod/bacilli

    non-lactose fermenting
  10. Pseudomonas
    gram negative rod/bacilli

    non-lactose fermenting
  11. Hemophilus influenzae
    gram negative

    respiratory pathogen
  12. Peptococcus
    Gram positive mouth anaerobes

    cocci
  13. Peptostreptococcus
    Gram positive mouth anaerobes

    cocci
  14. Clostridium

    (C. difficile, C. sp.)
    Gram positive gut anaerobe

    bacilli
  15. Bacteroides fragilis
    Gram negative gut anaerobes
  16. Mycoplasma pneumoniae
    Atypical respiratory pathogen
  17. Chlamydia pneumoniae
    Atypical respiratory pathogen
  18. Legionella pneumoniae
    Atypical respiratory pathogen
  19. Natural Penicillins

    Penicillin G (IV)
    Penicillin V (po)
    DOC: streptococcus

    some enterococcus coverage

    mouth anaerobes

    Probenecid administered shortly before or w/ PCN will increase PCN levels

    susceptible to degradation by beta-lactamases
  20. Penicillinase Resistant PCNs

    Nafcillin, Oxacillin (IV)
    Dicloxacillin, Cloxacillin (PO)
    DOC: staphylcoccus

    streptococcus

    hepatically eliminated

    may elevate liver enzymes; potential for hepatitis

    avoid extravasation

    DI: warfarin, nifedipine (naficillin): increases metabolism

    Do not administer together with aminoglycosides in the same compartment
  21. Amino-penicillins

    Ampicillin (IV;PO)
    Amoxicillin (PO)
    some gram-negative activity

    streptococcus

    enterococcus
    (only ampicillin)

    • enterobacteriaceae (limited)
    • -E. coli, Proteus

    H. influenzae

    Mouth flora

    Major ADR: hypersensitivity rxn (rash)

    • DIs:
    • OC;
    • methotrexate (increases methotrexate toxicity);
    • venlafaxine,
    • warfarin (increase INR, risk of bleeding)
    • Do not administer together with aminoglycosides in the same compartment

    Ampicillin causes C. diff colitis
  22. Extended-Spectrum Penicillins (IV)

    Ticarcillin (Carboxy-penicillins)
    Piperacillin (Ureido-penicillins)
    Piperacillin (broader spectrum than Ticarcillin)

    • Streptococcus
    • Enterococcus (Piperacillin only)

    • Enterobacteriaceae
    • Pseudomonas aeruginose (P>T)

    H. Influenzae (variable)

    • Mouth & Gut anaerobe
    • (only some coverage; cannot rely upon)

    ADRs: thrombophlebitis, injection site pain

    Do not administer together with aminoglycosides in the same compartment
  23. Penicillin plus B-lactamase inhibitors

    Augmentin (Amoxicillin/clavulanate) PO
    Unasyn (Ampicillin/sulbactam) IV
    Timentin (Ticarcillin/clavulanate) IV
    Zosyn (Piperacillin/tazobactam) IV
    • MAO:
    • 1) high-affinity & irreversible binding to B-lactamase preventing hydrolyses on penicillin

    2) directly bidning to penicillin-binding proteins of bacteria increasing antibacterial activity of penicillin

    inhibitors have no or little antibacterial activity
  24. 1st Generation Cephaloporins

    Cefazolin (IV)
    Cephalexin (PO)
    Cefadroxil (PO)
    SPEcK

    Gram positive: Staphylocci, Streptococci

    Gram negative: Proteus, E. coli, Klebsiella

    • 5-8% cross-sensitivity with PCN allergy
    • -used as an alternative in pts with mild PCN allergy
    • -dont give in pts with anaphylatic rxn
  25. 2nd Generation Cephalosporins

    Cefuroxime (IV)
    Cefonicid (IV)
    Cefuroxime axetil (PO)
    Cefaclor (PO)

    Cefprozil, Loracarbef (PO)

    Cefoxitin, Cefotetan (IV)
    HNM-SPEcK

    Gram positive: Streptococci

    Gram negative: Hemophilus influenzae, Neisseria gonorrhoeae, Moraxella catarrhalis, Proteus, E. Coli, Klebsiella

    • Cefoxitin, Cefotetan (IV)
    • -anaerobic activity: bacteroides fragilis
    • -SPEcK (no HNM)

    Cefotetan has MTT side chain: may interfere with prothrombin synthesis
  26. 3rd Generation Cephalosporins

    Cefotaxime, Ceftriaxone, Ceftizoxime, Ceftazidime (IV)

    Cefixime, Cefpodoxime proxetil, Ceftibuten, Cefdinir, Cefditoren pivoxil (PO)
    have expanded gram negative activity

    less gram positve activity

    • IV have good CSF penetration
    • -used in meningitis

    • ceftriaxone
    • -hepatically eliminated
    • -shouldnt be given within 48hrs of IV soln that contains Ca2+
    • -nephrotoxicity
    • -used for lyme disease, gonorrhoea & pneumonia
    • ceftazidime
    • -pseudomonas
  27. 4th Generation Cephalosporins

    Cefepime (IV)
    very broad spectrum

    enterobacteriacease

    peudomonas
  28. 5th Generation Cephalosporins

    Ceftraoline fosamil (IV)
    1st cephalosporin with activity against MRSA

    Broad spectrum bactericidal activity against gram (+) & gram (-) pathogens

    dose adjustment if CrCl <50 ml/min
  29. Aztreonam IV
    • Gram Negative ONLY
    • -incl. Pseudomonas

    mono-bactam

    no cross-senstivity with PCN

    no nephrotoxicity
  30. Carbapenems (IV)

    Imipenem-cilastatin
    Meropenem
    Ertapenem
    Doripenem
    Staphylococcus & Streptococcus

    E. Faecalis

    Gram-Neg (incl. Pseudomonas)

    Anaerobes (no C. Diff)

    Cilastatin prevents the degradation of imipenem in the renal tract

    Imipenem causes seizures

    • Meropenem
    • -gram (-) > gram (+)
    • -less ADRs with increased dosed
    • -lower incidence of seizures

    • Ertapenem
    • -narrower spectrum (no pseudomonas)
    • -good anerobic activity
    • -longest T1/2
    • Doripenem
    • -no neurotoxicity

    • ADRs:
    • -cross-sensitivity to PCN
    • -mental status changes & seizures
  31. Aminoglycosides

    Gentamicin, Tobramycin, Amikacin, Streptomycin, Capreomycin (IV,IM)
    Primarily Gram Negative

    • Staphylococcus (Gentamicin)
    • w. penicillinase-resistant PCN, cefazolin, or vanco
    • Streptococcus

    Enterococcus (w/ ampicillin & vanco)

    Gram-Neg (incl. Pseudomonas)

    Concentration Dependent Killer

    • ADR:
    • nephrotoxicity (reversible)
    • ototoxicity (not reversible)
    • neuromuscular blockade
    • Gent, Tobra:
    • -trough <2
    • -peak: for synergy=3-4; infections=6-10

    • Amikacin:
    • -trough <10
    • -peak: 15-30
  32. Vancomycin
    • GRAM-POSITIVE
    • -Staphylococcus (incl. MRSA)
    • -Streptococcus
    • -Enterococcus (bacteriostatic)

    C. difficile (only P.O use)

    • DOC: MRSA
    • alt. in pts with PCN allergic rxn

    • ADRs:
    • -"red man" syndrome
    • -ototoxicity (irreversible)
    • -nephrotoxicity
    • -neutropenia (reversible)
    • -hypersensitivity rxn

    monitor trough in only for pt w/ renal impairment
  33. Linezolid (Zyvox)
    • broadest gram-positive abx spectrum
    • -bacteriostatic

    staphyococcus (incl. MRSA)

    streptococcus

    enterococcus

    • hepatically eliminated
    • excellent bioavailability
    • -IV & PO
    • ADRs:
    • myelosuppression (reversible)
    • -usually occur after 2 weeks
    • -thrombocytopenia

    weak & reversible inhibitors of MAO

    • 5-HT syndrome
  34. Synercid
    quinupristin/dalfopristin
    • Gram-Positive
    • -Staphylcoccus (MRSA - bactericidal)
    • -Streptococcus
    • -E. faecium only (bacteriostatic)
    • -VRSA

    reserved for life-threatening or serious infections

    incompatible w/ normal saline

    hepatically eliminated

    • ADRs:
    • -arthralgias
    • -myalgias
    • -increases bilirubin

    inhibits cyp450 3A4
  35. Daptomicin (IV)
    (Cubicin)
    • Broad Gram-Positive Spectrum
    • -Staphylcoccus (MRSA)
    • -Streptococcus (incl. resistant species)
    • -E. Faecalis

    Renally excreted

    high PPB -- DI!!!

    • ADRs:
    • -myopathy; increases CPK levels
  36. Clindamycin
    Gram positive & anaerobes

    • Staphylococcus (no MRSA)
    • Streptococcus

    • Mouth anaerobes
    • Bacteroides fragilis

    100% bioavailability

    good alternative for PCN in staph/strep infections

    hepatically eliminated

    • ADRs:
    • -diarrhea (may be the cause for c. diff)
    • -bitter taste
  37. Metronidazole
    ANAEROBES

    • Mouth anaerobes - poor activity
    • Bacteroides fragilis (gut)
    • DOC: C. diff

    • hepatically eliminated
    • ADRs:
    • -metallic taste (chew gum, hard candy)
    • -Disulfiram rxn
    • -can induce seizures (rarely)
    • DI:
    • coumadin, carbamazepine, cyclosporin
  38. Tetracyclines
    Tetracycline (PO)
    Minocycline (IV/PO)
    Doxycycline (IV/PO)
    RESPIRATORY MOs

    Strep pneumoniae

    • Staph. aureus & epidermidis
    • -incl. MRSA
    • -only minocycline

    Resp. MOs

    • Atypical MOs:
    • -chlamydia pneumoniae/trachomatis
    • -mycoplasma pneumoniae
    • -legionella pneumoniae

    bacteriostatic

    • ADR:
    • photosensitivity
    • tooth discoloration

    • DI:
    • -chelation (2 hrs apart)
  39. Tigecycline
    Broad Spectrum

    staphlyococcus (MRSA)

    streptococcus (incl. resistant species)

    enterococcus (VSRA)

    gram-neg (no pseudo)

    Mouth anaerobes, bacteroides sp., clostridium sp.

    bacteriostatic

    adjust dose in severe hepatic impairment

    • ADRs:
    • -photosensitivity
    • -tooth discoloration
  40. Bactrim
    trimethoprim/sulfamethoxazole
    strep. pneumoniae

    enterobacteriaceae (variable)

    resp. MOs

    decrease dose by 50% if CrCl<50mL/min

    • ADRs:
    • -photosensitivity
    • -hypersensitivity rxns (SJS)
    • -bone marrow supression
    • -crystalluria (drink alot of fluid)

    • DIs:
    • -potentiate warfarin
    • -phenytoin
  41. Macrolides
    erythromycin, azithromycin, clarithromycin, roxithromycin, dirithromycin
    resp. & HIV

    • staph (no MRSA)
    • strep

    resp. MOs

    atypical & AIDs MOs

    H. pylori

    only Azithromycin should be taken w/o food

    • A --> least ADRs
    • E --> most ADRs

    • ADRs:
    • -VT, QT prolongation

    • All (except A) inhibit cyp450 3A
  42. Quinolones
    ciprofloxacin, levofloxacin, moxifloxacin, gemifloxacin
    Staph & Strep (except C)

    Enterococci (except C)

    Enterobacteriaceae

    Pseudomonas (only C & L)

    Resp. MOs

    Anaerobes (only M)

    atypical MOs (except C)

    • only Moxifloxacin is hepatically eliminated
    • concentration dependent killer

    • ADRs:
    • -seizures
    • -photosensitivity
    • -tendonitis
    • -QT prolongation (torsades)
    • -dysglycemias

    • DIs:
    • -antacids & cations (space out 3-4hrs)
    • -NSAIDs
    • -anticoags
  43. MRSA tx
    Vanocomycin (1st line)

    Zyvox (2nd line)

    Synercid (3rd line)

    Cubicin

    Minocycline

    Tigecycline
  44. VRSA tx
    Zyvox

    Cubicin

    Synercid
  45. Anaerobes tx
    Clindamycin

    Metronidazole

    Tigecycline
  46. Resp. Anaerobes tx
    tetracycline

    bactrim

    macrolide

    quinolone
  47. Abx that causes photosensitivity
    tetracycline

    tigecycline

    bactrim

    quinolones
  48. Nephrotox abx
    aminoglycosides

    vancomycin
  49. C. Diff tx
    Vancomycin (PO)

    Metronidazole (PO)
  50. Abx that can induce seizures
    Metronidazole

    Carbapenems

    Quinolones
  51. Hepatically eliminated abx
    Penicillinase-resistant penicillin

    Synercid

    Clindamycin

    Metronidazole

    Moxifloxacin

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