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MCPHS AntiBac Exam 3
MCPHS AntiBac Exam 3 P1c
| Question | Answer |
|---|---|
| Extn-Spec. Beta Lac (ESBLs) vs. Beta-Lac-ase? | 340 B-lac-ase (chrom. mediated) vs. 120 ESBLs (Plasma mediated) |
| ESBLs hydrolize ? | ESBLs hydrolized even when B-Lac-ase Inhibitor is present |
| AmpC Beta-Lac-ases? | SPACE-K: Serratia, Psuedomonas, Acinetobacter, Cintrobacter, Enterobacter, Klebsiella |
| Most Common Beta-Lac-ases? | Tem-1&2, SHV-1, Plasma Med gram(-) bacteria, |
| Quinolones cover? | Pseudomonas covered by Cipro & Levo (30% resistant) |
| Only 3rd Gen Ceph to Cover Pseudomonas? | Ceftazidime is only 3rd gen Ceph to cover Pseudomonas |
| Cefazolin Covers ESBLs, but Should Not Cover? | Cefazolin: Not Pseudomonas |
| Pen's and Ceph's Beta-Lactam structure? | Pen's are Pentagon & Ceph's are Hexagon Rings |
| Beta-Lactamases do what? | Open the ring |
| ESBL's open what rings? | ESBL's open 3rd Gen. Ceph's & Aztreonam's Rings |
| Non-Lactose Fermenting Think? | Non-Lactose Fermenting think Pseudomonas or Acinetobacter |
| ESBLs act on which 3rd Gen Cephs? | ESBLs Act on: Ceftreonam, Aztreonams, Ceftazidime, Ceftriaxone (used to kill SPACE-Ks) |
| ESBLs don't break down? | ESBLs dont break: Carbopenums & Cephamycins (Cefotetan & Cefazolin) |
| ESBLs come from ? | Surgery, broad spectrum use, Klebsiella (w/ plasma med. ESBLs) seeding Pseudomonas |
| Labs: ESBLs look for ? | ESBLs in Lab: Susceptable to Ceftriaxone but, Resistant to Ceftazidime |
| Lab ESBL marker? | Lab ESBL marker: Cefpodoxime Resistant Organisms are ESBLs |
| Overuse of Carbopenems lead to? | ESBL Pseudomonas |
| Pseudomonas come from? | Soil, Swamps, Farm land, Snow Making, Diesel Fuel (can harbor in Contact Lenses) |
| Tx for Pseudomonas? | 2 drug-Combo Tx for Pseudomonas: Beta-Lactam (Pen or Ceph)+ Aminoglycoside (Gent, Tobra, amikacin) |
| Imipenums do what? | Help build Pseudomonas resistance |
| Invitro Pseudomonas Tx demonstrates? | Tx Pseudomonas: Pip/Taz, Pip, Cefepime, Ticar/Clav, Cipro |
| Tx for Community aquired Pseudomonas (suspected)? | Pip/Taz + Aminoglycocide (esp. for bacterial translocation - sepsis) |
| Broad-Spec Gm(-) Coverage? | Broad Gm(-) = QCC-PTA: Quinolones, Ceftriaxone (not pseudomonas), Cefepime, Pip/Taz w/Aminoglycoside (Gent, tobra, Amikacin) |
| VAP causes? | Acinetobacter Infections (plastic in body) |
| Mech of Resistance by Acinetobacter? | Mech of Res: Antibiotic Alt-enzymes, Membrane Porins, DNA Gyrase |
| Carbo-Res-Acinetobacter linked to use of? | 3rd Gen Cephs & Aztreonam (imipenem use also increase Acinetobacter Resistance) |
| Polymyxin B not used for carbopen-resistant Acinebactor b/c? | 100% Renal Toxic |
| Tx for Acinetobacter? | Tx Acinetobacter (AI-AS-PT-CCC): Amikacin (88%), imipenem (50%), A/S, Pep/Taz (25%), Cephtaz, Cipro, Cefepime (25% effective...) |
| What causes ESBLs? | ESBLs Caused by: Use of 3rd Gen Cephs (Ceftazidime, cefotaxime, Ceftriaxone - But, ESBLs may be susceptable to Ceftriaxone while resistant to Ceftazidime) |
| What causes MDR-Pseudomonas? | MDR-Pseudomonas b/c of (use): Imipenems & Cipro |
| What causes MDR-Acinetobacter? | MDR-Acinetobacter b/c: Imipenem & 3rd Gen Cephs (Ceftazidime, Cefetaxime, Ceftriaxone (alone & w/ Aztreonam) |
| Acinetobacter Outbreak Risk Reduction (Institutional)? | Acinetobacter Outbreak Control: Restrict Ceftaz use, Education, Add Pip/Taz [Sub Ceftaz (or all ceph's) for P/T, A/B, or I/C] |
| Carbopenem use linked to increase what infections? | Carbopenem use: Acinetobacter infections |
| Prophylax Tx for MAC (w/HIV) | Prophylax Tx MAC/HIV: Azithromycin 1200mg/Wk until CD4+ >100 |
| MAC Sx's? | MAC Sxs: Diarrhea, marrow surpression |
| M. Kansasii? | Kansassii: Pts w/ HIV or Malignancy - Pulmonary Involvment, Diseminated (soil born org) |
| M. Marinum? | Marinum: Delayed Cutaneous, Sea Water, Single Nodual, (3-6 or 7 mos. Tx w/ Macrolides) |
| Rapid Growing Mycobacteria? | M. Rapid Growing Orgs: Fortuitum, Abscessus, Chelonae |
| INH LTBI Tx? | LTBI INH Tx: 300mg QD, D/C if LFTs >3x's ULN, Peripheral Neropathy (risks: al, preg, malnurished, DM, HIV) Tx w/ B6 vitamine 25mg QD, Rash/Lupus-like, Acetylators, Admin 2hrs prior to Antacids(if used), acts as MAOI |
| INH Inhibits Metabolism of? | Increases PC-WT: Phenytoin, Carbamazepine, Warfarin, Theophylline (INH Inhibits Met. causing Increase in Concentration of PCW&T) |
| RIF (Rifampin)? | RIF: TB, Kansasii, MAC, 600mg QD, Red Wine, GI, Rash, Feever, Anaphylactic, MOST Potent Inducer (don't use w/HIV - Alt Tx Afabrin or RBN), Dont Use when PC-IV-N, Adjust Dose when P-WE |
| w/RIF Do Not Use (PC-IV-N)? | RIF Do Not Use PC-IV-N: Protease Inhib, Contraceptives, Itraconazole, Voriconazole, Nevirapine |
| w/RIF Dose Adjust (P-WE)? | RIF Adjust P-WE : Phenytoin, Warfrin, Efavirenz |
| RBN (Rifabutin)? | RBN: Alt. Tx Rifapentine & RIF, 5mg/Kg QD, Uveitis (vitreous Opacity), Can be Admin w/HIV meds (protease inhib dose adjust), 3A4 substrate, Adjust (CPA) |
| w/RBN adjust (CPA)? | RBN Adjust CPA: Claritho, Protease, Azole |
| Rifapentine? | Rifapentine is Not for HIV, 10mg/kg Q Weekly |
| PZA (Pyrazinamide)? | PZA Tx's: TB, 25mg/kg QD (max 2gm - Must Know Pt's Wt.), GI, Uric Acid w/gout Sx's, trans Rash, No Sig Drug Interactions |
| EMB (Ethambutol)? | EMB Tx's: (TB, MAC, Kansas) Retro-Bulbar Neuritis (R/G visual) monitor(>2mos/Renal), CNS ADRs (Renal), Antacids Reduce Absorption |
| EMB txs? | EMB: TB, MAC, kansasii (ADRs R/G, Antacids Reduce EMB) |
| Macrolides Tx? | Macrolides Tx: All but TB |
| Clarithro (Macrolide) ADRs? | Clarithromycin: Taste, QT-interval increase synergisticly, Potent CYP 450 inhibitor, Dose Adjust (WP-STA): warfrin, protease, statins, theophylline, anticonvulsants, w/food(fats, chocolate) |
| Azithro (Macrolide) MAC Tx? | Azithro: Alt. Tx to Clarithro for MAC, No CYP, w/food, Prophylax (1200mg/WK), Therapeutic Tx (500mg QD) |
| Quinolone (Cipro 1A2 /Levo) MAC, Kans, Fort, 2nd-Tb Tx? | Cipro/Levo: MAC, Kansassii, Marinum, Fortuitum, (2nd Line TB Tx), Renal (dose adj), Photosens, HA, QT, Glucose-imbal, ADRs Cipro(IA2) > Levo, Sep dosing w/multi-valent cations (4-6 hrs) or Chelation, Sunscreen |
| Aminoglycosides (Streptomycin) M. Tx? | Streptomycin: 15 mg/Kg IV 2-3x's Wk, PEAK 20mcg/ml, NO Throughs, AuditoryTox, NephoTox, Hep-tox, Avoid in Liver Disease (death tox), Contact MD if Dizzy, Tennia, Imbalance, Monitor Creatinine for Nephotox |
| How long can Aminoglycosides (streptomycins) be used? | a few weeks (limit tx durration for aminoglycosides) |
| M. Tx w/ Tetracyclines (Doxy & Minocycline)? | Doxy & Minocycline: Marinum, Fortuitum, Chelonae - Photosens, sunscreen, ft w/H2O, (drug rxns w/phnytoin, carbamazepine, phenobarbital: decreases tet's 1/2 life) |
| M. Tx w/ Cefoxitin/Imipenem? | Cefoxitin 2 gm IV, Imipenem 500mg IV, Q 6-8 h, cefoxitin off market now, Seizures (imipenem: renal insuf.), GI, Nephritis, Infussion issues, Tx's absessus, fortuitum, chelonae |
| M. Tx. w/ Bactrim? | Bactrim: Marinum, Fortuitum, Chelonae, Absessus, dose depn on indications, Photosens, sunscreen, H2O, CBCs for Marrow Supression |
| M. Tx. w/ Clofazamine? | Clofazamine: TB (2nd Line), Orange/Brown Skin/Fluids, N&V, diarrhea, color issues prolong long after D/C use |
| Beta-Lactamase-Resistant-Penicillins? | B-Lac-ase Res-Pen's: Nafcillin, Cloxacillin, Oxacillin |
| Carbopenems? | Carbopenems: Imipenem/Cilastatin (I=active/C=reduces renal excretion, used vs. Pseudomonas), Meropenem, Ertapenem (Not Pseudomonas) |
| Macrolides? | Macrolides: Ery, Azithro, Clarithro, Dirithomycin |
| RIF No? | Rif No (PC-IV-N) |
| RIF Adj? | RIF Adj: W-PE |
| RBN (3A4) Adj? | RBN Adj: CPA |
| RBN ADR? | Uveitis |
| PZA ADR? | Increase Uric Acid w/gout sxs, no sig drug interactions |
| EMB ADR? | R/G, antacids decrease absorption |
| Clarithomycin ADR? | Taste, QT, CYP inhib (Adj: WP-STA) |
| Clarithro tx's? | MAC |
| Azithro Tx? | MAC (Prophalax 1200/Wk) |
| Azithro ADRs? | None (GI take w/food) |
| Cipro & Levo ADRs? | Sunscreen, Chelation, Agitation/HA (1A2) |
| Strepto ADRs? | Hepato, Nephro, Audio Toxic (Contact MD if Dizzy, Tennia, Bal) No Liver Disease ! Goals 20mcg/ml w/no Thro's (RESERVED TX) |
| Cefoxitin & Imipenem ADRs? | GI, Seizure, Infussion issues, (Ceftoxitin off Market) |
| Doxy & Mino (Tet's) ADRs? | Sunscreen, Rash, H2O, PCP decreases Tets by 1/2 |
| PCP interaction in Tet's? | Phenytoin, Carbamazepine, Phenobarbital |
| Bactrim ADRs? | GI, Sunscreen, H20 (stones), CBCs (marrow) |
| M. Clofazimine ADR? | N&V, Orange/Brown Skin/Fluids Presists after D/C |
| LTBI No Combo Tx With? | No RIF + PZA w/LBTI tx |
| Mono LTBI tx? | INH 300mgx270d (9 mos) or RIF 600mgx120d (4 mos) |
| MD-TB tx? | Initial: INH, RIF, PZA, EMB (#56-40, 2-3mos) Continuation: INH, RIF (#182-130, 4-6mos) |
| TB HIV CoInfections Don't? | TB/HIV NO: BIW <100 CD4+, No INH + Rifapentine |
| Kansasii Tx Duration? | Kansasii: 18 mos (same tx as TB but, w/out PZA, ie. 3-drug regiem) |
| Marinum (superficial) Duration? | Marinum (superficial): 3-6 mos w/ Claritho mono tx |
| Marinum (deep) Duration? | Marinum (deep): 7 mos (Clarithro, Tetracycline, RIF) or (Clarithro, EMB, RIF) |
| MAC Tx Duration? | MAC: 18-24 mos w/ (Clarithro + EMB) +/- RBN |
| Rapid Growers Tx? | Resist: 1st-Line TB Tx's, Clarithro activie vs all, quinolones, amikacin, cefoxitin, Imipenem, (6-12 mos) |
| Rapid Growers? | Abscessus, Fortuitum, Chelonae |
| Absessus tx? | Absessus: Clarithro, Amikacin, Cefoxitin (3-6 mos) plus Surgical resection |
| Fortuitum (pulmonary) tx? | Fortuitum: Clarithro + Doxy or Bactrim or Levo |
| Chelonae (Cutaneous) tx? | Chelonae (Cutaneous): (CC) = Claritho + Cipro (6-12 mos) |
| Chelonae (Systemic) tx? | Chelonae (systemic): (Clit) = Claritho, Imipenem, Tobramycin (aminoglycoside) |
| Narrow Therapuetic Drug Abrev.s? | Narrow: (DET) = Digoxin, anti-Epileptics, Theophyline |
| anti-Epileptics Abrev? | anti-Epileptic: (PPC) = Phenytoin, Phenobarbital, Carbamazepine |
| "Red Flag" Drugs Abrev? | Red Flag: (WM-PC) = Warfrin, MAOIs, Protease Inhib, Cyclosporine |
| CYP Inhibitors (universal) Abrev? | CYP Inhibitors: (ICE-P) = Itraconazole, Cimetidine, Erythomycine, Protease Inhib |
| CYP Inducers (Universal) Abrev? | CYP Inducers: (CBS-RIF) = Carbamazapine, Barbituates, Smoking, & RIF |
| A Pharmaceutical Interaction (example)? | Pharm. Interact: Phenytoin & Saline (stable for 1/2 hour only) |
| Chelation (non-absorb examples)? | Chelation: Quinalones & Tetracyclines w/ Cations (Mg, Ca, Fe, Al) Cipro/Levo vs. Sucralfate (Al) |
| GI Acidity (non-absorb)? | GI Acidity (non-abs): (Itraconazole, Ketoconazole, or Dapson) Vs. (H2's, PPI's, or Didanosine *buffers) hard to separate so, D/C H2s or PPIs |
| Choestryramine binds with? | Choestryramine Binds: Digoxin, Warfrin, Levo, Flagyl, niacin |
| Distribution/Displacement Interactions? | Distribution: (WT-MP vs. SAC) = (Warfrin, Tobutamide, Methotrexate, Phenytoin) vs. (Sufonamides, Asprin, Chloralhydrate) *cause increase conc. of displaced drug increasing ADRs |
| CYP 450 IA2 Substrates? | 1A2 Substrates: Theophyline, Caffeine, Acetaminophen, Fluoxamine, Rasagiline |
| IA2 Inducers? | 1A2 Inducers: RIF, Smoking, Charcoal, phenytoin, phenobarb, ritonavir, st. Johns |
| 1A2 Inhibitors? | 1A2 Inhibitors: Cipro, Clarithro, Erythro, Cimetidine |
| Only Inhibiting 1A2 Quinolone? | Cipro is the only quinalone to inhibit 1A2, Alt choices Levo, Gati, Moxi... |
| The Classic Universal Inducer? | Universal Inducer: RIF |
| 2C9 Substrates? | 2C9 Subs: WOP-V (Warfrin, Omeprazole, Phenytoin, Voriconazole) |
| 2C9 & 2D6 Inducers? | PPCs & RIF (induce 2C9 & 2D6) |
| 2C9 Inhibitors? | 2C9 Inhibitors: Flagyl, INH, Bactrim, Omeprazole, Cimetadine, Fluoxeine, Fluoxamine, Valproic Acid |
| Example of 2C9 interaction? | 2C9: Warfrin vs. Bactrim *monitor adj warfrin down if needed |
| 2D6 metabolises? | 2D6 Met. Codeine to Morphine |
| 2D6 interaction (example)? | Codeine vs. Ritonavir (2D6 Inhib) *looks like Pt is drug seeking |
| 3A4 Substrates? | 3A4 Subs: Macro's, Cyclosporin, Sildenafil, Warfrin, -azoles, -statins, -zolams, Benzo's (NOT LOT), Ca-Chan-Blkr's, quinidine, amiodarone |
| Benzos NOT 3A4 substrates? | LOT (Lorazapam, Oxazapam, Tamazopam) *Not 3A4's |
| 3A4 Inducers? | 3A4 Inducers: RIF, PPCs, Carbamazepine, st. John's |
| 3A4 Inhibitors? | Cipro, Macro, Telithro, Protease, -azoles, INH, grapefruit juice |
| Examples of 3A4 interactions? | 3A4: RIF vs. (Contraceptives or Voriconazole) |
| Only -Azole NOT 3A4 Inhibitor? | Fluconazole: NOT 3A4 Inhib. |
| Only Quinalone 3A4 Inhibitor? | Cipro: Only 3A4 Inhibitor |
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