Pharm PCN Vanco Clinda

  1. How does IDSA categorize skin and soft tissue infections?
    Purulent vs non-purulent
  2. What is the usual organism found in purulent skin infections?
    Staphylococcus aureus
  3. What is the usual organism found in non-purulent skin infections?
    Group A Streptococci
  4. What are characteristics of non-purulent skin infection?
    • Necrotizing infection
    • Cellulitis
    • Ersipelas
  5. What are the characteristics of purulent skin infection?
    • Furuncle
    • Carbuncle
    • Abscess
  6. What is the initial treatment for a severe skin infections?
    Empirically treat with vancomycin and piperacillin/tazobactam, if suspected Staph. aureus, must cover MRSA
  7. What route of administration would you use to treat moderate non-purulent skin infection?
  8. What is the drug used to treat moderate non-purulent skin infection?
    IV penicillin
  9. What route of administration would you use to treat mild non-purulent skin infection
  10. What are the drugs used to treat mild non-purulent skin infections?
    Oral penicillin or dicloxacillin
  11. What is the drug used to treat moderate purulent skin infection?
    Oral TMP or doxy
  12. What is the drug used to treat severe purulent skin infection?
    IV Vancomycin
  13. What is defined therapy?
    It is after you do a C&S and have a target organism, can then deescalate abx treatment
  14. What is the mechanism of action of clindamycin?
    Inhibits protein synthesis by binding to 50S ribosomal subunits of microbe
  15. Which bacteria do clindamycin target?
    • Gr+ aerobes such as Group A and B Streps, S.penumoniae and S.aureus including MSSA, MRSA
    • Gr- anaerobes such as Bacteroides
  16. True/False: Clindamycin has antimicrobial activity on Gr- aerobes like E.coli
    False; Clindamycin targets Gr+ aerobes and Gr- anaerobes
  17. What are some clinical indications for clindamycin?
    • Oral and IV forms to treat systemic infections; Necrotizing fasciitis
    • Topically to treat acne
    • Intravaginally to treat for bacterial vaginosis
  18. If a patient is allergic to beta-lactam (penicillin), is it safe to give clindamycin?
  19. How would you treat Necrotizing fasciitis?
    Penicillin G and Clindamycin
  20. What are the adverse side effects of Clindamycin?
    • Diarrhea (from oral form)
    • At risk to develop C.diff colitis
  21. Is Clindamycin a good drug for MSSA / MRSA?
    Not anymore, it used to be. Now, it is only about 79% MSSA susceptible and 72% MRSA susceptible to clindamycin
  22. Is Clindamycin a good drug for Bacteroides?
    Not anymore, it used to be.
  23. What is the mechanism of action for penicillin?
    Inhibit cell wall synthesis
  24. What makes penicillin unique?
    It has beta-lactam , which is a four sided ring
  25. How does beta-lactam affect bacterial cell wall?
    Inhibit the formation of bacterial cell wall by binding to the transpeptidase enzyme which inhibit the cross-linking of the peptidoglycan
  26. What happens to the bacteria cell that is without cross-linking of peptidoglycan?
    Weakened cell wall, leading to intracellular osmotic pressure and rupturing of cell wall
  27. How do bacteria become resistant to penicillin?
    They develop a different transpeptidase (penicillin binding protein) where penicillin cannot bind
  28. What is beta lactamase and what is the significant of it?
    It is a bacterial enzyme that can breakdown beta-lactam (penicillin), thereby resistant to Penicillin
  29. How do Gr- bacterial resistant to penicillin?
    • Outer membrane permeability
    • Efflux pump
    • B-lactamase production
  30. What are the B-lactamases produced by Gr- bacteria?
    • ESBL (extended spectrum B-lactamases)
    • KPC (Klebsiella penumoniae carbapenemases)
    • MBL (Metallo-B-lactamases: NDM, IMP, VIM)
  31. Bacteria that produce ESBL enzymes can be killed by which abx?
    Carbapenem antimicrobial
  32. Bacteria that produce carbapenemase (KPC, MBL) are resistant to what?
    Most beta-lactam antibiotics
  33. What are the four types of penicillin?
    • Natural penicillin
    • B-lactamase resistant
    • Aminopenicillins
    • Extended spectrum penicillin
  34. What are natural penicillins and what are they a drug of choice for?
    • Penicillin G (IV, IM depot)
    • Pencillin V (oral)
    • Drug of choice for Group A Strep
  35. What are B-lactamase resistant penicillin and what are they a drug of choice for?
    • Oxacillin
    • Naficillin
    • Dicloxacillin
    • Drug of choice for MSSA
  36. What are aminopenicillin?
    • Ampicillin
    • Amoxicillin
  37. What are extended spectrum penicillin?
    • Ticarillin (supplied with clavulanic acid)
    • Piperacillin (supplied with tazobactam)
  38. Which penicillin contain B-lactamase inhibitor?
    • Ampicillin plus sulbactam (IV)
    • Amoxicillin plus clavulanic acid (oral)
    • Ticarcillin plus clavulanic acid (IV)
    • Piperacillin plus tazobactam (IV)
  39. Which drug can be used to prolong the half-life of penicillin?
  40. Is penicillin safe during pregnancy?
  41. What are some adverse reactions for penicillin?
    • Seizures from high levels
    • Cause C.diff infection
  42. Which bacteria are penicillin most effective against?
    Gr+; GAS, GBS, S.pneumonia, MSSA
  43. True/False: Penicillin is good against MRSA?
  44. What is the mechanism of action of Vancomycin?
    Inhibition of bacterial cell wall synthesis
  45. What is the antimicrobial spectrum of activity for vancomycin?
    • Gr+ aerobes
    • Gr+ anaerobes
  46. What are the bacteria targeted by vancomycin?
    • GAS, GBS
    • Strep. pneumo
    • MSSA, MRSA
    • Clostridium difficile
    • Enterococci
  47. Is vancomycin the drug of choice for MRSA?
  48. How does vancomycin disrupt the cell wall synthesis?
    Bind terminal ALA-ALA on peptide chain to prevent peptidoglycan cross-link
  49. How do vancomycin resistance develop?
    D-Lactate replaces the last Alanine on NAM peptide so no vancomycin binding
  50. Which route of administration of vancomycin is optimal for MRSA and MSSA?
  51. What does oral/rectal routes of administration of vancomycin useful against?
    C.diff because of local effect
  52. What are some possible adverse effects of IV vancomycin?
    • “Red neck” syndrome when infusing IV doses too rapidly
    • Allergic reaction
    • IV administration leads to vein irritation or phlebitis
    • Nephrotoxicity
    • Ototoxicity
  53. How to avoid high peak levels of vancomycin?
    Slow infusion rate
Card Set
Pharm PCN Vanco Clinda
NMSK EXAM 2 Pharm abx for soft tissue/ skin infections