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Medical Studies 1 > 8.4 Pharmacological Management of Respiratory Infection > Flashcards

8.4 Pharmacological Management of Respiratory Infection Flashcards

1
Q

What was the mortality rate of TB before anti-TB treatment

A

~50% (!)

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2
Q

Did increased duration of antibiotic therapy decrease or increase relapse rates of TB?

A

Decrease

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3
Q

Should you ever use a single antibiotic when treating tuberculosis?

A

No; this could lead to resistance

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4
Q

Should you ever add a single antibiotic to a failing TB regimen?

A

No; this could lead to resistance

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5
Q

Are tuberculosis drugs free in Australia?

A

Yes

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6
Q

What is DOT in TB treatment? Why is it important?

A
  • DOT (directed observed therapy) is when a trained healthcare worker or someone else (not family member) watches the patient swallow each dose of their drugs
  • This prevents antibiotic resistance, relapse, and improves mortality rates
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7
Q

What are the two phases of pharamcological TB treatment?

A
  • Intensive phase (bactericidal)
  • Continuation phase (sterilisation)
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8
Q

What occurs during the intensive (bactericidal) phase of TB treatment? How long does it last?

A
  • Kills of actively dividing TB population
  • Lasts for at least 2 months
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9
Q

What occurs during the continuation phase (sterilisation) of TB treatment? How long does it last?

A
  • Semi-dormant/dormant persistor cells are formed during the intensive phase; this phase kills them
  • Lasts for at least 4 months
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10
Q

What is the most potent drug used during the bactericidal phase of TB treatment?

A

Isoniazid

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11
Q

What is the most potent drug used during the sterilisation phase of TB treatment?

A

Rifampicin

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12
Q

List some important ways of ensuring treatment completion during tuberculosis

A
  • DOT
  • Developing a partnership with the patient
  • Monitoring for side effects
  • Patient support measures
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13
Q

Under what circumstances should we especially consider DOT for TB treatment?

A
  • All infectious
  • Drug resistant cases
  • Cultural/language issues
  • Elderly/mental health issues etc.
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14
Q

Is TB treatment short or long in duration? How does this impact the probability of developing antibiotic resistance?

A
  • Long in duration
  • Provides many opportunities for interruption (acquired resistance)
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15
Q

How can healthcare providers directly CAUSE antibiotic resistance to TB

A

By ‘breaking the rules’ (using/substituting one drug). Bad idea.

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16
Q

What patient factors can cause drug resistant TB?

A
  • Malabsorption
  • Non-adherence
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17
Q

What is the main source of drug-resistant TB?

A

Transmission from others

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18
Q

Approach to treatment of drug-resistant TB

A
  • Start with 4-5 drugs of proven susceptibility (that they haven’t been given before)
  • Keep testing until it works
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19
Q

How do the drugs used in drug-resistant TB differ from those in regular TB?

A
  • More toxic
  • More expensive ($100k vs $400)
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20
Q

Does drug resistant TB require a mulidisciplinary approach of treatment?

A

Yes

21
Q

How many susceptible drugs should you use at once during TB treatment of regular, susceptible TB?

A

3-4

22
Q

Describe the radiological presentation of lobar pneumonia

A

Consolidation of a single lung lobe

23
Q

Describe the radiological presentation of bronchopneumonia

A

Patchy; involving one or several lobes

24
Q

Describe the radiological presentation of interstitial pneumonia

A

Interstitial inflammation histologically and radiologically

25
Q

Describe the radiological presentation of miliary pneumonia

A

Millet seed like opacities (Tb)

26
Q

Describe the investigations you could do in a patient with suspected pneumonia

A
  • CXR +/- CT chest
  • Blood culture
  • Sputum microscopy and culture
  • Viral PCR
  • Pleural fluid aspirate and culture
27
Q

Why is it important to determine the aetiology of community acquired pneumnonia?

A
  • Public health reporting/epidemiology
  • Providing directed therapy
  • Adjusting when initial empiric therapy is unsuccessful
28
Q

List some test findings that provide a definite aetiology of pneumonia

A
  • Isolation of bacterial pathogens from blood or pleural fluid
  • Isolation of legionella from respiratory secretions (it’s not usually there)
  • Legionella antigen in urine
29
Q

Can the aetiology of pneumonia be found in a majority of cases?

A

No, over half cannot.

30
Q

Should you delay antibiotic treatment in order to gather specimens for pneumonia diagnosis? Why not/why?

A
  • No, you would not
  • This can have very bad outcomes
31
Q

A patient has no signs of lung consolidation on x-ray, but is coughing and spluttering. Do you give antibiotics? Why/why not?

A
  • No you don’t
  • They probably have a virus
  • Don’t give antibiotics unnecessarily
32
Q

In pnuemonia treatment, do we generally prefer antibiotics with a wide or thin therapeutic window (initially)?

A

Wide

33
Q

In a patient with severe pneumonia, do we prefer bactericidal or bacteriostatic antibiotics?

A

Bactericidal

34
Q

If you know which bacteria is causing a patient’s pneumonia, should you use broad spectrum or thinner spectrum antibiotics?

A

Thin; Charlie-Munger strategy

35
Q

How soon after clinical improvement of pneumonia should you switch to oral antibiotics?

A

ASAP

36
Q

Which has a broader spectrum: amoxycillin or penicillin?

A

Amoxycillin

37
Q

Is penicillin mostly able to kill gram-positive or gram-negative bacteria?

A

Gram positive

38
Q

What is a common antibiotic than can be used instead of penicillin if they are allergic?

A

Cephalosporins

39
Q

Is cephalosporin used as a first-line antibiotic? Why/why not?

A
  • No
  • It can cause side effects including resistance and infection
40
Q

Macrolides suffix

A

-mycin

41
Q

What type of antibiotics could you use if you suspected that a patient had “atypical” tuberculosis?

A
  • Macrolides
  • Tetracyclin
42
Q

Macrolides side effects

A
  • GI side-effects
  • Hepatitis (erythomycin)
43
Q

Tetracycline suffix

A

-cycline

44
Q

What % of pneumonia-causing bacteria are fully penicillin susceptible? What % need a higher dose, and what % are fully resistant?

A

Fully susceptible: 80%
Higher dose: 19%
Fully resistant: 1%

45
Q

Are antibiotics more likely to negatively impact pregnant women in early or late pregnancy?

A

Late

46
Q

What immunisations should be considered for pneumonia patients?

A
  • Influenza
  • COVID-19
  • Pneumococcal
47
Q

What is pneumococcal disease?

A

Any disease caused by strep pneumoniae

48
Q
A

Medical Studies 1 (90 decks)

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