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MCPHS AntiBac Exam 2
| Question | Answer |
|---|---|
| Antibiotic Degrdating Enzymes | Pen-ase, Ceph-ase (ermB MICs >32mcg/ml) opens beta-lac ring |
| Efflux Pump | Macrolides, Quiolones (mef A, Low ,<=16mcg/ml) |
| antibiotic alt enzyme | alt antibiotic before it can attack cell |
| Porin Channels | cell senses chem/antibiotic outside and changes charge to resist it from passing through porin channel |
| Pen Drugs | Pen, Amp, Amox (augmenten can be used against Degradating Enzyme Bugs) |
| Macrolides | Ery, Azithro, Clarithromycin |
| Quinolnes | Norflox, Ciproflox, Oflox, Levo, Gati, Moxifloxacin |
| 1982 - 91' Drug Development? | 82 2nd Gen Cephs, 85 3rd gen Cephs, 87 FQs, 88 Biaxin(macrolide), 91 Oflox (driv of Levofloxacin FQs) |
| Atypicals CAPs (age related) incidence goes way up w/age | s. pneumo, m. pneumo, Legionella, c.pneumo |
| Pen Resistance goes way up from when? | 1991 to now |
| s. pneumo prevlence in usa | 25% macrolide resistant in USA (erm B methyl)Efflux (mef A Lower MIC) 75%in USA (mic 1-32) |
| Drug of Choice for RTIs? | FQs: Levo, Gati, Oflox... |
| FQs resistance mech? | DNA gyrA, DNA top IV ParC & E, Efflux Lower incidence, (orgs res to FQs: gut, peudomonas, e. coli,klebsiella, mrsa, enterococcus |
| HK drug use? | Cipro and FQs high (high resistancant strains too) |
| Levo cross-resistance with? | Levo cross-res w/ FQs |
| CAP most Rxd? | Azith, Levo,Clarith |
| ceftriaxone associated with what? | increase in CDIF(CDAD) |
| VREs caused by | Pip-taz,Metronidazole, clindamycin, Augmen, mero, vanco |
| reduce resistance by ? | selection, dose, duration |
| CAP Tx duration? | Tx till Afibril for 72 hr (s. pneumo) |
| Nigeria study tx for S. Pneumo? | Stop after afebrile for 24 hrs OK |
| Two ways to kill bac? | Conc & time dependent |
| Conc Dep (auc/Mic or Cmax/MIC) drugs? | Conc dep: Aminos, FQs |
| Aminoglycosides? | gent, tobra, amikacin |
| FQs? | levo, gati, moxi, norflox, ciproflox |
| FQ auc/mics for gm +/-? | auc/mic gm- >125, gm+ >30 |
| Time dep killers (time above MIC? | (time abov MIC) Pens and Cephs |
| macrolides & azalides are? | time dep killers too (auc/mic) (macro: azith, clarith, eryth) |
| beta lac ? | pe, amp, amox, pep, tricar, nafcill, oxacill |
| Levo is good at ? | getting into ELF (azith is better at macrophage penitration) |
| 2xs MIC by NCCL standards increase % for which drug? | 3rd gen Cephs (but, FQs levo, moxi, gati, still better than ceftriaxone) |
| s. pneumo mech changed? | PBPs |
| s.pneumo tx? best drugs to use? | Pen, cephs, macro (cipro is worse does nt cover s.peumo) (levo is good) |
| macro resistant can tx with? | beta lac ok to tx for macro-res org. |
| tx CARTI? | Augmen, Cephs, Macro/azalides, FQs, Bactrim, Tetra, Keolides |
| Collateral damage? | (least w/ macro for CARTIs) next is beta lac, then worse is FQs, but FQs are best for tx resistant stains right now |
| simple chronic bronhitis tx with? | Macrolides (azith, clarth, 2 & 3rd gen cephs, dox, amox, bactrim) |
| complicated bronchitis tx with? | FQs or Aug |
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MCPHS
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