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thera II test III infectious disease
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the quntitative ability of an organism to cause disease
virulence
3 virulance factors
adherence
invasion
toxigenicity
indirect contact route of transmission 2
clostridium difficile
contaminated medical supplies
respiratory droplet transmission 3
> 5microm in size
transmissible < 6 feet
influenza
airborne transmission 3
<
5 micorm in size
transmissible over long distance
mycobacterium tuberculosis
water or food-borne route of transmission 2
often fecal-oral
escherichia coli
environmental route of tranmission 2
pathogen ubiquitous in environments
aspergillus sp. (fungi,mold, yeast)
3 key pathogen gram positive bacteria groups
staphylococcus
streptococcus
enterococcus
3 key pathogen gram negative bacteria
cocci
bacilli (rods)
coccobacilli
3 gram negative cocci
neisseria meningitidis
N. gonorrhoeae
moraxella catarrhalis
1 gram negative coccobacilli
heamophilus influenzae
3 gram-negative bacilli (rods) GNRs
enterobactericiae
E. coli
Klebsiella
3 key pathogen fungi
caidida species
apsergillus species
blastomyces dermitiditis
4 steps process to using antimicrobial agents appropriately
confirm presence of infection
identification of the pathogen
selection of empiric therapy
monitoring therapeutic response
3 (non-test) ways to confirm the presence of an infection
history and physical
signs and symptoms
predisposing factors
3 S&S of infection
fever - not very specific
white blood cell count
local signs
which method of confirming the presence of infection can be the most specific
local signs
elevated in bacterial infection
neutrophils (50-70%)
also band forms
elevated in viral, TB or fungal infection
lymphocytes
increased in TB or lymphoma
monocytes
increased in allergic reactions or parasitic infection
eosinophils
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
initiation of treatment prior to determination of a firm diagnosis
empiric therapy
therapy with a culture test to identify the bug and sensitivities
definitive therapy
3 concomitant medications for antimicrobials
fluoroquinolones or bactrim + warfarin = doubled INR
metronidazole + alcohol
AGs or FQs + multivaltent cations (milk) = chelation
what is the suseptiblilty ratio you are looking for on the antibiogram
>90%
4 drug factors when picking a therapy
spectrum of activity
pharmacokinetics
toxicity % monitoring
cost
2 toxicities present with almost all antimicrobials
photosensitivity
diarrhea
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
6 drugs with 100% bioavailabilty for IV to PO switch
Doxycycline
Linezolid
Fluoroquinolones
TMP/SMX
Metronidazole
Fluconazole
what does a coagulase test differentiate
staphylococcus species
what is a coagulase (+)
staph aureus
what is coagulase (-)
staph epidermidis
what is blood agar used to differentiate
hemolytic properties
a-hemolytic designates
partial hemolysis
green color
strep pneumonia or strep viridians
b-hemolytic represents
complete hemolysis
clear
strep pyogenes - group A or B
gamma hemolytic represents
no hemolysis
enterococcus
if D-test shows inducible resistance what don't you use
clindamycin
lactose non-fermenter bacteria
pseudomonas aeruginosa
lactose fermenter bacteria
E. Coli
klebsiella sp
enterobacter sp
if you had conflicting results from a sensitivity test and an antibiogram, which one would you go off of
sensitivity most of the time
an example of a bug that is intrinsically resistant to a drug
e.coli to vancomycin
an example of a bug that has acquired resistance
MRSA & VRE
4 mechanisms of bug resistance
target site alteration
drug inactivation
target inaccessibility
metabolic by-pass
2 primary methods for antimicrobial susceptibility testing
qualitative
quantitative
lowest antimicrobial concentration that prevents visible growth of an organism after approximately 24 hrs of incubation in a specified growth medium
minimal inhibitory concentration
MIC cut-off values that signify a bacterial population as sensitive, intermediate or resistant
breakpoints
lowest drug concentration that kills 99.9% of an inoculum
minimal bactericidal concentration
what does it mean when the MBC exceeds the MIC by
>
32 times
the organism is considered tolerant to the antibiotic
which 10 drugs cover MRSA
vancomycin
clindamycin
daptomycin
doxycycline
minocycline
tigercycline
linezolid
ceftaroline
quinpristin/dalfoprisitin - synercid
bactrim
which antimicrobial don't you use for pneumonia
daptomycin
which antimicrobial don't you use for UTI
moxafloxacillin
which antimicrobial don't you use for P. aeruginosa
piperacillin/tazobactam
which drugs cover pseudomonas 9
3rd gen cephalosporins
ceftazidime
cefepime
carbapenem
meropenem
imipenem
doripenem
monobactam
aztreonam
fluoroquinolone
levofloxacin
ciprofloxacin
aminoglycosides w/ another agent
what is the drug of choice of extended-spectrum b-lactamases (ESBLs)
carbapenem
Tx option for carapenem resistance
tigecycline
colistin
2 time-dependent antibiotic groups
b-lactams
macrolides
4 concentration-dependent antibiotics
aminoglycosides
fluoroquinolones
metronidazole
daptomycin
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
1 gram (-) coccobacilli
H. influenza
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ID
216754
Card Set
thera II test III infectious disease
Description
thera II test III infectious disease
Updated
2013-05-06T23:32:53Z
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