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Pulmonology > 08.19 - Drug Tx of Bacterial Infections (Sweatman) - Questions > Flashcards

08.19 - Drug Tx of Bacterial Infections (Sweatman) - Questions Flashcards

1
Q

Unproductive cough in pneumonia suggests

A

Viral or mycoplasma etiology

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2
Q

Most important factor in successful treatment of pneumonia is

A

early intervention

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3
Q

2 most common causes of nosocomial pneumonia

A

S Aureus; P Aueruginosa

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4
Q

Most common cause of pneumonia in DM or Alcoholic

A

Klebsiella Pneuminae

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5
Q

Most common etiology of pneumonia in 18-40 yo

A

Mycoplasma Pneumoniae

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6
Q

Tx of Legionnaires

A

Azithro or Carithromycin

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7
Q

Respiratory Quinolones

A

Levofloxacin, Cirpofloxacin, Moxifloxacin

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8
Q

Who gets Legionnaires

A

Men >50; Smokers/Chronic Lung Dz; Immunocompromised

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9
Q

Abx for Outpatient, no modifying factors

A

Macrolide or Doxycycline

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10
Q

1st gen macrolide? 2nd? 3rd?

A

Erythromycin, Clarithromycin, Azithromycin

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11
Q

For aminoglycoside, you should think

A

Gentamicin

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12
Q

Abx for Outpatient, COPD, no steroids or abx in 3 months

A

2nd gen Macrolide or Doxycycline

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13
Q

MOA for Macrolides

A

50s ribosomal inhibitor: Blocks translocation

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14
Q

MOA for Tetracyclines

A

30s ribosomal inhibitor: Blocks protein synthesis

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15
Q

MOA for Fluoroquinolones

A

DNA Gyrase inhibitor: Prevents DNA replication

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16
Q

MOA for Penicillins

A

Block cell wall cross-linking

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17
Q

MOA for Carbopenem

A

Blocks cell wall cross-linking

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18
Q

MOA for Cephalosporins

A

Inhibit cell wall cross-linking

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19
Q

MOA for Aminoglycosides

A

30s Ribosomal inhibitor

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20
Q

Resistance mech for Macrolides

A

Ribosomal methylation and mutation of 23S rRNA; Active efflux

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21
Q

Resistance for Tetracyclines

A

Decreased entry and increased efflux; Target insensitivity

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22
Q

Resistance for Fluoroquinolones

A

Mutation of DNA Gyrase; Active efflux

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23
Q

Resistance for Penicillins

A

Drug inactivation (b-lactamase); Altered PBPs; Decreased permeability of gram positive outer membrane; Active efflux

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24
Q

Resistance for Cephalosporins

A

Drug inactivation (b-lactamase); Altered PBPs; Decreased permeability of gram positive outer membrane; Active efflux

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25
Q

Resistance for Aminoglycosides

A

Drug inactivation ; Decreased perm of gram neg outer membrane; Active efflux; Ribosomal methylation

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26
Q

No etiologic agent in ___% of nosocomial pneumonia

A

50%

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27
Q

3 indicated drugs for most nosocomial pneumonia

A

Impipenem/Cilastin; Aztreonam; Ceftazidime

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28
Q

When should Vancomycin be used

A

MRSA

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29
Q

50% of isolates in hospitalized patients with aspiration pneumonia are

A

Gram negative enteric bacilli

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30
Q

Abx for Aspiration Pneumonia

A

Clindamycin

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31
Q

MOA of Clindamycin

A

50S ribosomal inhibitor

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32
Q

MOA of Vancomycin

A

Binds D-alanyl-D-alanine terminus of the peptide precursor units, inhibiting peptidoglycan polymerase and transpeptidation reactions

33
Q

Resistance for Vancomycin

A

Replacement of D-ala by D-lactate

34
Q

Oral bioavailability in Doxycycline and Fluoroquinolones

A

High, so easy to administer orally

35
Q

3 important parameters for defining drug activity

A

AUC/MIC, Cmax/MIC, T>MIC

36
Q

Characterize AUC/MIC, Cmax/MIC, T>MIC

A

Concentration-dependent: AUC/MIC, Cmax/MIC; Time-dependent: T>MIC

37
Q

Concentration-dependent means that increase in abx conc leads to more

A

rapid rate of bacterial death

38
Q

Time-dependent means that reduction in bacterial density is proportional to

A

time that concentrations exceed MIC

39
Q

Concentration-dependent drugs are often given

A

in large doses at long intervals relative to serum half-life

40
Q

Time-dependent drugs are often given

A

more frequently, with emphasis on need to maintain serum drug level above MIC for 30-50% of dose interval

41
Q

Renally eliminated drugs (adjust for renal impairment)

A

Amoxicillin, Ampicillin, Cefazolin, Cefepime, Ceftazidime, Gentamicin, Imipenem, Levofloxacin, Meropenem, Piperacillin, Vacomycin

42
Q

Toxicity of Amoxicillin, Ampicillin

A

Maculopapular Rash

43
Q

Toxicity of Azithromycin

A

Jaundice; QT prolong

44
Q

Toxicity of Cephalosporins

A

Cross-reactivity with penicillin hypersenstivity

45
Q

Toxicity of Doxycycline

A

Teeth; Photo; Decr bone growth

46
Q

Toxicity of Erythromycin

A

Same as Az + CYP3A4 inhibitor

47
Q

Toxicity of Gentamicin

A

Nephro and Ototoxicity; Neurmuscular paralysis

48
Q

Toxicity of Imipenem

A

Pen/ceph hypersensitivity; Seizures

49
Q

Toxicity of Levofloxacin

A

Tendon/Cartilage

50
Q

Toxicity of Linezolid

A

Bone marrow suppression; MAOi

51
Q

Toxicity of Meropenem

A

Pen/ceph hypersensitivity; Seizures

52
Q

Toxicity of Piperacillin

A

Decr coagulation

53
Q

Toxicity of Vancomycin

A

Nephro and Ototoxicity; Red Man’s Syndrome

54
Q

Abx with developmental dysfunction toxicity

A

Doxycycyline

55
Q

Abx with unusual organ dysfunction toxicity

A

Gentamicin, Vancomycin, Erythromycin; Imipenem, Meropenem; Levofloxacin

56
Q

Other classes, besides penicillin, with beta-lactam ring

A

Cephalosporin, Carbapenem

57
Q

Abx caution with breastfeeding

A

Clarithromycin, Linezolid, Metronidazole, Piperacillin, Doxycycline

58
Q

Teratogenic Abx

A

Clarithromycin, Doxycycline, Erythromycin, Gentamicin, Levofloxacin, Linezolid, Metronidazole, Trimethroprim

59
Q

What is paired with Amoxicillin

A

Clavulonic Acid

60
Q

What is paired with Piperacillin

A

Tazobactam

61
Q

What is paired with Ampicillin

A

Sulbactam

62
Q

What is paired with Imipenem

A

Cilastin

63
Q

Function of Cilastin

A

Reversible, competitive inhibitor of DHP-1, which breaks down imipenem to inactive, nephrotoxic metabolites

64
Q

Reversible, competitive inhibitor of DHP-1, which breaks down imipenem to inactive, nephrotoxic metabolites

A

Function of Cilastin

65
Q

Why is Daptomycin not used for pulmonary infections

A

Inactivated by surfactant

66
Q

Most episodes of bronchitis in young patients are

A

Viral

67
Q

Etiology of bronchitis in most older patients

A

Bacterial

68
Q

Most common etiology of bronchitis in smokers

A

H. Influenzae

69
Q

4 abx indicated for bronchitis

A

Amoxicillin, Azithromycin, Clarithromycin, Doxycycline

70
Q

Lung abcesses resolve with tx within

A

2 months

71
Q

Gram positive cocci in lung abscesses are usually ___-aquired

A

Community

72
Q

Gram negative bacilli in lung abscesses are usually ____-acquired

A

Nosocomial

73
Q

Abx for community acquired lung abscess

A

Clindamycin

74
Q

Abx for nosocomial-acquired lung abscess

A

Metronidazole + Ceftriaxone

75
Q

Clindamycin is superior to penicillin vs

A

Bacteroides

76
Q

For CAP, a ___ or ___ is appropriate 1st choice

A

Macrolide or Respiratory Quinolone

77
Q

Alternative option for CAP

A

Amoxicillin/Clavulanate

78
Q

Tx for abscesses and aspiration pneumonia should cover

A

Oral Anaerobes

Pulmonology (31 decks)

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