29: Drugs for Cardiopulmonary Infections

Question 1

three groups recommended to get the s. pneumoniae vaccine

Answer 1

1. all children <2 years
2. immunocompromised adults 19+
3. Adults 65+

Question 2

inhibiting which two things is most important in killing gram + vs gram - bacteria

Answer 2

1. inhibiting DNA gyrase -> gram negative

2. inhibiting Topo IV -> gram positive

Question 3

multridrug resistant vs extensively drug resistant vs pandrug resistant

Answer 3

1. multidrug (MDR): not susceptible to 1+ agent in 3 classes
2. extensively drug resistant (XDR): not susceptible to 1+ agent in all but two classes
3. pandrug (PDR): not susceptible to all antimicrobial agents

Question 4

three species most reported with pandrug resistance

Answer 4

1. pseudomonas
2. acinetobacter baumannii
3. klebsiella pneumoniae

Question 5

examples of 1st-5th gen cephalosporins

Answer 5

1. cefazolin, cephalexin
2. cefotetan, cefoxitin
3. ceftriaxone, cefpodoxime, cefditoren, ceftazidime
4. cefepime
5. ceftaroline

Question 6

antibiotic that used to be heavily used for aspiration PNA that was linked to C. diff

Answer 6

clindamycin

Question 7

“nasty” PNA bugs and the mnemonic for it

Answer 7

ESKAPE: e. coli, staph, klebsiella, acinetobacter baumannii, pseudomonas, enterococcus

Question 8

RFs for MDR VAP

Answer 8

1. IV Abx use in last 90 days
2. septic shock at time of intubation
3. 5+ days hospitalization
4. acute renal replacement therapy

Question 9

RFs for MDR pseudomonas

Answer 9

1. tx in ICU where 10+% of pathogens are resistant to first line agent
2. tx in ICU where local antimicrobial susceptibility is unknown
3. prior MDR pseudomonas

Question 10

RFs for MRSA

Answer 10

1. tx in a unit where 10-20+% of Staph aureus isolates are methicillin resistant
2. tx in a unit where MRSA prevalence is unknown
3. prior MRSA

Question 11

valve affected in 90% of right sided endocarditis cases

Answer 11

tricuspid valve

Question 12

tuberculosis cell wall

Answer 12

rich in lipids and waxes

Question 13

what are mycobacteria tuberculosis resistant to?

Answer 13

disinfectants, detergents, common Abx, dyes, stains, lethal oxidation, etc.

Question 14

how slow does Tb grow on media?

Answer 14

6-8 weeks - slow!

Question 15

what is important to monitor while treating for Tb?

Answer 15

liver function

Question 16

Methotrexate can cause malignant lymphomas - what is the typical treatment for this?

Answer 16

likely wont need treatment and will regress following withdrawal of methotrexate