Small Ani. Medicine- Intro to clinical pharmacology and antibiotic use

wilsbach's version from 2015-11-04 19:08

durgs er mer gerd

Question Answer
what should we know about dead bugs?DEAD BUGS DON'T MUTATE
3 main goals of using antimicrobials?(1) effective concentrations (2) KILL the microbe (3) Must take into account host/microbe/drug
do you prefer ciproflox or enroflox in a dog?enro..because cipro isnt bioavailable in dogs
**what causes aplastic anemia in owners???chloramphenicol
(mini pharm review)Antimicrobials interfering bacterial cell wall synthesis (4)(1) Βeta-lactams (Penicillins, Cephalosporins, Carbapenem& monobactam) (2) Bacitracin (3) Vancomycin (4) Cycloserine
(mini pharm review)Antimicrobials acting on bacterial cell membrane (2)(1) PolymyxinB (2) Colistin
(mini pharm review)Antimicrobials interfering bacterial protein synthesis---> 30S ribosomal subunit (2)(1) tetracyclines (2) Aminoglycosides
(mini pharm review)Antimicrobials interfering bacterial protein synthesis---> 50S ribosomal subunit (3)(1) Chloramphenicol and derivatives (2) Macrolides (3) Lincomycin
(mini pharm review)Antimicrobials interfering bacterial nucleic acid synthesis (3)(1) Fluoroquinolones (2) Rifampin (3) Metronidazole
(mini pharm review)Antimicrobials interfering bacterial folic acid synthesis (2)(1) Sulfonamides (2) Diaminopyrimidines
Narrow spectrum (3)(1) Beta-lactams(Natural penicillin) (2) Aminoglycosides (3) PolymyxinB and colistin ****just know these are narrow so the rest are broad
when would you not want to use a abx that works on the cell wall?L form bact: mycoplasma, ureaplasma....they have no cell wall to work on!
Type I antimicrobial is what?conc dependent
Type II antimicrobial is what?time dependent
Type III antimicrobial is what?Time dependent killing kinetic + Post-antibiotic effect
3 groups that are bacteriostatic?(1) Acetamides-- chloramphenicol (2) Macrolides/lincosamides-- Azithromycin, Clindamycin, Tylosin (3) Tetracyclines
7 groups that are bacteriocidal?(1) Aminoglycosides (2) Carbapenems (in the beta lactam group) (3) Cephalosporins (4) Nitroimidazoles (Metronidazole) (5) Penicillins (6) Quinolones (like fluoroquinolones) (7) Potentiated sulfas
If you use Azithromycin and it isnt helping at all, should you switch to clindamycin?no, they are both macrolides/lincosamides which means there is cross resistance
what part of the body do you think of when you hear cephalexin (a Cephalosporin)?skin
Aminoglycosides--> what two drugs do you think of?amikacin and gentamycin
pros and cons of aminoglycosides? (what are the two main aminoglycosides?) (amikacin and gentamycin) you will never ever pick amikacin or gentamycin as first line EVER-- they *KILL KIDNEYS!!! So don't pick them first, but are very effective when needed
kidney killers?Amikacin and gentamycin (aminoglycosides)
explain time dependent antimicrobials. How do you inc efficacy?DURATION is most important. Increase the frequency of administration to increase efficacy
explain conc dependent antimicrobials. How do you inc efficacy?Dose is most important-- Increase the dose to increased the efficacy
If you give subpar doses of enrofloxacin, what other things can resistance affect?esistant to enro AND clava and ampi, and 3gen cephalos
which abx can cause resistance to LOTS of other abx, and how can you help avoid this?resistance of enrofloxacin can cause resistance in LOTS of other abx- So give the HIGHEST DOSE YOU CAN once a day (conc dependent)
is enrofloxacin time or conc dependent?conc
is ampicillin/sulbactam time or conc dependent?time
things you need to consider about the infecting organism?Gram + vs. Gram –, Aerobic vs. anerobic, Intracellular vs. extracellular
what are the G+ bact? (there is an acronym)"SS BEC CLARE DAMN" which is... Streptococcus, Staphylococcus, Bacillus, Erysipelothrix, Clostridium, Corynebacterium, Lysteria, Archanobacter, Rhodococcus, Enterococcus, Dermatophilus, Actinomyces, Mycobacterium, Nocardia
gram positive is what color?purple/blue....G- is pink
listeria does what?gives cows head tilts
Clinically significant anaerobes? (7) (there is an acronym)"ABC-EF-PP" Actinomyes(facultative), Bacteroides, Clostridium, Eubacterium, Fusobacterium, Peptostreptococcus, Porphyromonas
most normal anaerobic flora live in what three places?(1) mouth (under the gumline) (2) vagina (3) intestines
when do infections with anaerobes usually happen? What is a sign that isn't always present but often indicates an anaerobic infection?in IMMUNOCOMPROMSED patients....often will be inside abscesses. You can often identify an anaerobic infection by the fact they produce GAS in the infected tissues.
What kinda baddies are you worried about with a cat bite wound?cat teeth are like little needles that slide in and then slide out and the wound closes up--> ANAEROBIC ENVIRONMENT
if you have an anerobic infection, aside from abx, what else should you do?Treatment will also include debridment and drainage
C&S stands for...Culture and SUSCEPTIBILITY, not sensitivity
4 reasons culture and susceptibility is so important?(1) Identifies the organism (2) Detects resistant organisms (3) Identifies less toxic or expensive drugs (4) Provides the basis for dose modification
is clavamox time or conc dependent?it's a penicillin-- time dependent
what is "empiric use"? therapy begun on the basis of a clinical educated guess in the absence of complete or perfect information.
how would you differ in your approach from a dog that has gotten its first UTI, versus a dog which has had recurring UTIs?on the first time dog, it is ok to use abx empirically without a C&S. However, if there is recurring episodes, you NEED to do a C&S
So a dog comes in with some nasty infection and you want to be a good vet and do C&S...but you are concerned that this infection is really bad and you're worried about leaving it until the results come back. What do?you can empirically use abx while you are WAITING for the C&S, and then can switch over to something else if the C&S tell you otherwise
what are Difficult organisms to culture which might merit using empirical use of abx if you don't think you'll get anything back?Ehrlichia, Borrelia, hemoplasmas, Bartonella, mycoplasmas
If there is a critically ill patient, do you want to do C&S?YES! you just start tx empirically and then if the C&S prompts, change course after results
things that might be considered critical illness?Life threatening infections, Overwhelming sepsis, Systemic inflammatory diseases, Bacteremia
which route of admin would you like to use in a critical illness?parenteral (not per os)
for critical ill pts, you want to admin parenteral abx for how long?at least 3-5d
what do you want dosing range/dosing interval like for ciritcally ill pts?High end of the dosage range, Low end of the dosing interval (ie, more frequently)-- so basically as high and frequent as possible
which two abx have good prostate penetration?enro and chloram good for prostate penetration (potentiated sulfas too)
*****Aminoglycoside tox?(amikacin and gentamycin) Nephrotoxic, Ototoxic
*****Cephalosporins and Penicillins tox?DO NOT USE WITH immune mediated dzs (Can cause aggregations)
why do you want to make sure that if you are prescribing an ear drug, that the tympanum is intacT?lots of ear drugs have GENTAMYCIN in them, which is a AMINOGLYCOSIDE, which is OTOTOXIC
******Esophageal strictures in cats**?Doxycycline
Doxycycline causes what problem?ESOPHAGEAL STRICTURES IN CATS
why does doxy cause strictures of the eso ESP in cats?because if it's given as a tablet, the cat doesnt swallow it and it gets stuck in the eso and sits on it. Try doxy in syrup form, or put the tablet into a capsule and lube it
*****Tetracyclines tox?Renal tubular disease, Tooth enamel (becomes dayglow orange)
what give animals orange teeth?TETRAcycline
eso strictures in cats is....DOXYcycline (cats dont like doxins)
renal tubular dz?TETRACYCLINES (aminoglycosides aka amikacin and gentamycin, also are toxic to kidneys, but this tubular dz is for tetras) tubular tetras
what is blood dyscrasia?(anything going wrong in the bone marrow)-- can get anmemia, polycythemic...anything.
******tox of Sufonamides?KCS***, Blood dyscrasias, Polyarthritis (Dobies)
what drug has SE of KCS?sulfonamides
what drug has SE of Blood dyscrasias?sulfonamides (sulfur in your bad)
which drug has SE of polyarthritis...and in WHO?sulfonamides in DOBERMAN (black and tan dogs at higher risk)
*****Enrofloxacin tox?BLINDNESS IN CATS, +/- seizures, Failure of cartilage development in young animals
Failure of cartilage development in young animals caused by...enrofloxacin
If you need to choose between a possible side effect like cartilage damage or orange teeth, in an emergency case..better a deaf/ugly dog than a dead one
enrofloxacin or marbofloxacin in cats?MARBO-- enro will make them blind
which drug has possible SE of seizure?enrofloxacin
*****Chloramphenicol tox?Aplastic anemia in HUMANS****--> client compliance is NECESSARY
which drug arguibly has the most urgent need for client compliance--and why?Chloramphenicol- clients MUST wear gloves because it can cause aplastic anemia in humans
****Metronidazole tox?CNS signs
which abx has SEs which can affect the CNS?metronidazole
for a simple infection in an immunocompetant individual, how long is a regular abx course? (few things to consider also)7-10 days of appropriate antibiotic (need to consider site of infection and presumed infectious organism)
in simple infestions with an immunocompetant individual, how many days should you continue abx after resolution of clinical signs?Continue 1-2 days post resolution of clinical signs
complicated infections are what kinda infections? what is tx going to be like?things like Chronic infxns, bone infxns, infxns in immunocompromised patients. Will NEED to do a culture and susceptibility, and treatment will be LONG TERM
Cutaneous infxn--> what do you use to tx Staph pyoderma?Cephalosporin
Cutaneous infxn--> what do you use to tx Abscesses? (3)Clavamox (beta lactam), Clindamycin (Lincosamides), Cephalosporins (beta lactams)
Cutaneous infxn--> what do you use to tx nocardia?High dose penicillins + potentiated sulfa
cardiopulmonary dz--> Bacterial pneumonia--> what do you use to tx?will need a -Combination therapy- of Ampicillin high dose, q6h PLUS Enrofloxacin, 20 mg/kg q24h in dogs (Cats=marbofloxacin) ---- OR----- Ticarcillin/clavulanate
cardiopulmonary dz--> pyothorax--> what do you use to tx?Penicillins +/-potentiated sulfa and +/-metronidazole
cardiopulmonary dz--> Upper Respiratory disease--> what do you use to tx? (2)Clavamox (beta lactam), Clindamycin (lincosamide)
hepatic and GI infections--> Cholangiohepatitis---> what do you use to tx?Clavamox, +/-metronidazole
whos prone to colangioheapatitis?cats
hepatic and GI infections-->Bacterial overgrowth---> what do you use to tx? (2)Metronidazole, Tylosin
hepatic and GI infections-->Hepatic encephalopathy---> what do you use to tx?Neomycin
what's clostridium look like?tennis rackets and oval tennis balls (those are the spores)
all poop has might you know if the poop bugs are problematic?normal poop has all sorts of diff kinds of bugs. if overgrowth of ONE type, prolly a problem
whats Discospondylitis? infection of the spinal vertebrae and intervertebral discs. It is a form of vertebral osteomyelitis (bone infection)
musculoskeletal--> Diskospondylitis--> what do you use to tx? (2 main choices then 2 possible add ons)Cephalosporin, Clavamox, +/-enrofloxacin, +/-chloramphenicol**(i think the stars mean look out for owner aplastic anemia)
musculoskeletal--> Osteomyelitis--> what do you use to tx? (2)Clindamycin, Clavamox
She says anaerobes...what drug is she thinking of? (And what tissues?)Clindamycin...esp for bone and teeth
musculoskeletal--> Toxoplasmosis--> what do you use to tx?Clindamycin
CNS infections---> Encephalitis--> what do you use to tx? (3)Chloramphenicol **, Potentiated Sulfas, Quinolones
why'd she have a pic of a floppy eared dog in the CNS infection slide?ear infections can ascend into the CNS
CNS infections---> Toxoplasmosis--> what do you use to tx?clindamycin
CNS infections---> Otitis media/interna--> what do you use to tx? (2)Clavamox, Chloramphenicol**
if an ear infection made its way into the brain, which drug has good BBB penetration to reach it?Chloramphenicol**
(i dont think we have to memorise, but..) Good Levels of BBB penetration without Meningeal Inflammation? (7)Chloramphenicol, Sulfonamides, Metronidazole, Trimethoprim-sulfamethoxazole, Isoniazid, Rifampin, Pyrazinamide
polyarthritis--> if you see this, what are you thinking (cause)?TICK BOURNE DZ
Polyarthritis-->Bartonella--> tx with what?Azithromycin
Polyarthritis-->Borrelia and Ehrlichia--> tx with what?doxycycline
urogenital infections--> UTI--> tx with?clavamox (first instance of UTI, put on this. if keeps getting it.. C/S and clavamox while waiting for C/S. and then when C/S comes back, then can see if wanna change it )
urogenital infections--> Leptospirosis --> tx with? (explain the special way you're going to go about this)if lepto, START 2 ABX AT SAME TIME: Ampicillin for the bacteremia, and Doxycycline for the renal carriers
urogenital infections--> prostate --> tx with? (3)Enrofloxacin, Potentiated sulfas, Chloramphenicol*
which drugs cross the blood-prostate barrier? Enrofloxacin, Potentiated sulfas, Chloramphenicol*
urogenital infections--> pyometra --> tx with?The big guns-- Combination therapy of Ampicillin, enrofloxacin
how might a differentiate a pyometra from some GI thing on rads?remember uterus starts from back and goes foreward
who outlines Judicious Therapeutic use of Antimicrobials?AAHA