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Corissa.Stovall
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Gram positive stain color
purple
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Gram negative stain color
pink
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gram positive aerobes
- enterococcus
- listeria
- staphylcoccus
- streptococcus
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gram positive anaerobes
clostridium (c-diff)
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Intracellular bacteria have no ____?
Examples
cell wall
- Rickettsia
- Legionella
- Mycoplasm
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Examples of protozoa with antibacterial susceptibility
- chlamydia
- malaria
- pnemocystis
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Gram negative anaerobes
bacteroides- below belt, usually peritoneal or gynecological
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Protozoa with limited susceptibility
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Gram positive are ____ soluble
lipid
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gram negative are ____ soluble
water
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Side effects of all antibiotics
KNOW FOR TEST
- superinfection- broad spectrum, higher risk
- ex-oral candidis, yeast infection, c-diff
- -diarrhea
- -gi upset
- - allergy
- -
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SE of FQ and Macrolides
prolong QT interval
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SE of beta-lactams and FQ
seizures
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SE - FQ, Sulfa, Tetracycline
photosensitivity
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SE- FQ and tetracylcine
chelation
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SE- AG and IV vanco
Ototoxic
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SE IV Vanc
red mans syndrome
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drugs that are safe with renal impairment
- azithromycin
- ceftriaxone
- clindamycin
- metronidazole
- tetracycline
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bactericidal drugs
kill the organism, but the organism must be growing generally
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bacteriostatic drugs
inhibit growth, allowing host responses to overcome infection
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Cell wall active drugs (generally bactericidal)
- Beta lactams:
- PCN derivatives
- Cephalosporins (1st and 3rd generation better for gram + drugs) 2nd generation better for gram - drugs
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anti staph drug DOC
TEST!!!!
oral dicloxacillin (beta-lactam)
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Protein synthesis inhibitors
- macrolide (static)
- clindamycin (static)
- linezolid (static)
- aminoglycosides (cidal)
- tetracyclines (static)
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DNA disrupters
sulfamethoxazole/trimethroprim- septra or bactrim
fluoroquinolones- cipro, levaquin, avelox
metronidalzole -flagyl
rifampin
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bacteriostatic antibiotics are _______ spectrum
broader
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# 1 way to prevent spread of infection
handwashing
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Colonization
don't have sx
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PCN drugs are bactericidal so bacteria must be ______ in order to kill them
growing
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Beta lactams will not work if bacteria does not have _____?
- cell wall.
- will not kill pnemonia
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Drug that is contradicted in neonates because it can displace bilirubin and cause kenicterus
ceftriaxone
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way to remember anti staph drugs
ox, diclox, meth, naf all antistaph
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If pregnant women has syphilis and has an allergy to PCN what do you treat her with?
PCN just desensitize her first.
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Empiric therapy is for how long?
TX based on
72 hours
- likely pathogens, local susceptibility trends, and patient specific factors, (allergies, organ dysfunction)
- Broad coverage antibiotics until specific pathogen is identified.
Get cultures on front end and then start antibiotic asap
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Definitive tx with antibiotics
- identify organism (microbiology, or serologic testing)
- Use most effective, least toxic, narrowest spectrum, and most cost effective agent
- (may be a combination of drugs)
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Penicillin benzathine procaine
vs
penicillin benzathine
Know for test
pcn benz procaine- treats strept pharyngitis, has local antisthetic effect
pcn benz- used to treat syphillis
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First line tx for AOM and neonatal meningitis
aminopenicllins (ampicillin, or amoxicillin)
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First line cephalosporin
Tx's gram + or gram - ?
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2nd generation cephalosporins
- better for gram -, some anaerobes, less gram+
- cefuroxime (ceftin)
- tx- early lyme disease
- aom/ uri
-
-
compound was originally isolated from a microorganism
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first line tx c-diff
metronidazole
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What to do with expired tetracyclines
throw away
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SE of tetracycline
photosensitivity, chelation
don't give to kids under 8 years b/c stains teeth
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aminoglycosides enter through where?
Give what with if treating gram + bacteria
enter through pores in gram negative cell wall
Have to give with betalactam if gram + so it can break down cell wall first.
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aminoglycoside spectrum
aerobic gram negative, give with cell wall agent if gram +
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aminoglycoside toxicity
Test???
neuromuscular blockade
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clindamycin (above the belt) does not work on
c-diff
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what abx stains contact lenses orange and makes body fluids orange
rifampin
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do not use rifampin alone, it is only used alone ______
prophylactically
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Food or drug interaction with Flagyl
- no ETOH for 72 hours after tx.
- will make them very sick- called disulfiram reaction
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Listeria
gram positive that is not a coccus
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Drugs with cell wall synthesis
- beta lactams- pcn, cephalosporins
- Vanc
- Isoniazid
- polymixin
- bacitracin
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Nitrofurantoin (Macrobid, macrodantin)
tx's what
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Drugs that inhibit DNA replication
Quinalones
- Metronidazole
- Cipro
- Levaquin
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Drugs that inhibit RNA synthesis
Rifampin
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Drugs that inibit protein synthesis (50S) ribosome
-
-
Drugs that inhibit protein synthesis (30S) ribosomes
- Aminoglycosides
- Tetracyclines
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Drugs that are antimetabolites
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Cells must be actively growing for _____?
penicillin to do the killing
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What organisms are resistant to beta-lactams
organisms without cell walls
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Do not use ___ to treat mononucleosis
amoxicillin, will cause rash
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Most beta lactams are ____ cleared?
with the exception of ______
renally
ceftriaxone (rocephin)- undergoes biliary elimination (causes kernicterus in neonates)
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3rd line cephalosporin
IV/IM ceftriaxone- rocephin
- CAP- community acquired pnemonia
- gonorrhea
- meningitis
- AOM
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Tetracycline
bacteriostatic, or cidal?
drugs
narrow or broad spectrum
bacteriostatic
tetracycline (PO), doxycycline (IV or PO), minocycline (IV or PO).
broad spectrum- many gram +, gram -, toxin secreters (cholera), rickettsia, sphirochetes, mycoplasma, and chlamydia (intracellular)
Often effective against community acquired MRSA
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First line tx for COPD exacerbation
Tetracyclines (bacteriostatic)
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Aminoglycosides
cidal or static ?
drugs?
MOA?
requires what to work?
bactericidal
Gentamycin, Neomycin, streptomycin,
MOA-binds to irreversibly to a site of 30S subunit, preventing inhibition of protein synthesis, leading to cell death.
requires 02, will not work against anaerobic infections.
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Aminoglycosides spectrum
bactericidal
- aerobic gram negative, including pseudomonas
- Give with cell wall agent (beta lactam) if gram +
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Macrolides (bacteriostatic)
drugs?
MOA?
Spectrum?
Azithromycin (Zithromax), clarithromycin, erythromycin
MOA- bind to 50S ribosome subunit, inhibit peptidyl transferase and blocks release of peptide chain
Spectrum- some gram +, gram -, and intracellulars, h pylori
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2nd line tx for c-diff
oral vancomycin
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Adverse effects of macrolides (Zithromax, clarithromycin)
- ototoxicity
- hepatotoxic
- diarrhea, cramping
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Clindamycin (macrolide)
MOA
Spectrum
Cleared
MOA- binds with 50S, preventing translocation
Spectrum- gram +, some gram -, including anaerobes, but NOT c-diff
Tx's stuff above the belt, ie- skin infections with pcn allergy.
Cleared hepatically so safe in renal impaired
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Treatment for VRE
Linezolid (zyvox) - Macrolide
Don't want to get linezolid resistance because VRE is very hard to treat
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Linezolid SE
MAOI inhibitor
Head ache, thrombocytopenia, neuropathy
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Don't take quinolones or flouroquinolones if .....
pregnant or with a glass of milk
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FQ drugs
- cipro- usually tx gram -
- Levoflox
- Moxiflox- covers bacteroides (a below the belt anaerobe) but does not achieve urinary levels
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adverse effects of FQ
- chelation
- photosensitivity
- QT prolongation
- tendinitis
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Folate antagonists drugs
Spectrum
- sulfonamides- sulfa, silvadene, sulfadoxine
- DHFR inhibitors- Pyrimehtamine (malaria), trimethoprim
- Pneumocystis jiroveci
- CA-MRSA
- protozoa
- UTI
- toxoplasma
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Adverse effects of folate antagonists
- Sunburn
- anemia
- Steven Johnson syndrome
- LOTS OF SE
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Rifampin- drug that interferes with RNA polymerase
MOA:
Spectrum:
USE:
Adverse Effects:
MOA- form very stable complex with RNA polymerase. low affinity for human enzyme
Spectrum- love to kill bacteria in the phagasome- very broad including mycobacterium
- USE- monotherapy is only for prophylaxis for meningitis
- Combo tx for tb, leprosy, bone infections
- Adverse effects- body fluids orange/red
- hepatotoxic, flu like hypersensitivity, many drug interactions (decrease effectiveness of oral contraceptives)
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Flagyl (metronidazole) (below the belt)
spectrum:
Adverse effects:
spectrum: protozoa, anaerobes, h pylori, FIRST LINE FOR C-DIFF, diverticulitis.
- Adverse effects- neurotoxic effects- ototoxicity, and neuropathy.
- NO alcohol within 72 hours of treatment, will make patient deathly ill.
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Nitrofurantoin (Macrobid and Macrodantin)
Spectrum
Adverse effects
- spectrum- e coli, enterococci
- ONLY TX LOCAL CYSTITIS
AE- pneumonitits, pulmonary fibrosis, neurotoxicity.
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Drugs for TB
RIPE
- never monotherapy for active infection
- rifampin
- isoniazid
- pyrazinamide
- ethambutol- test for color blindness before use
- ALL THESE DRUGS ARE HEPATOTOXIC
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Tx for vaginal candidis
oral fluconazole (diflucan)
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Drug for viral herpes
Acyclovir and valacyclovir
Remember hydration, hydration, hydration
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What is dual tropism
- can use both doors to enter cell!!
- Assess for this when treating HIV
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What is used to reduce odds of passing HIV from mother to newborn
TEST!!!
Zidovidine- used during labor and delivery as prophylaxis for maternal to fetal transmission
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Treatment for HIV
HAART
- highly active antiretroviral therapy
- -partial therapy and non compliance causes resistance.
If you discontinue these drugs you must consider the half life of each drug
Don't use rifampin with these drugs (enzyme inducer)
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