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Respiratory Exam 2 > Anti-Microbials > Flashcards

Anti-Microbials Flashcards

1
Q

list the 14 anti pseudomonals

A

FQs: cipro and levofloxacin

monobactam: aztreonam
carbapenems: all 4 (*imipenem and meropenem)
cephalosporins: ceftazidime, cefepime

Piperacillin, carbenicillin

aminoglycosides: gentamicin, tobramyicn, amikacin

colistin

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2
Q

rx for outpatient w/ no recent AB use

A

macrolide (G+, H flu, A) or doxy (G+,G-, A)

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3
Q

preferred macrolide for H flu

A

azithromycin

erythromycin is ineffective against H flu, causes GI distress

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4
Q

moa of macrolides

A

inhib 50S

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5
Q

macrolide toxicities

A

prolonged QT (monitor when pts taking other drugs like Class Ia or III AARD)

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6
Q

macrolide drug interactions

A

inhibit CYP3A4, increased effects from many drugs like warfarin

not as much inhibiton from azithromycin

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7
Q

other effects of macrolides

A

anti inflammatory

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8
Q

moa of doxycycline

A

30S inhibitor

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9
Q

doxy toxicities (4)

A

prolonged QT (monitor w/ other drugs)

photosensitivity (UV converts drug to immunoreactive form)

tooth discoloration

teratogenic- accumulates in bone and interferes with developement

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10
Q

PK issues w/ doxy

A

chelates cations and becomes insoluble

avoid taking w/ Ca, Mg, Al, Fe, Zn

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11
Q

rx for outpatient w/ comorbidities or recent AB use

A

FQ (G+/G-/A)

or B-lactam (G+/G-) and macrolide

avoid same drug as previously used

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12
Q

major respiratory FQs

A

levofloxacin, moxifloxacin, gemifloxacin

cipro is not effective against strep pneumo so not used

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13
Q

FQ moa

A

DNA synthesis inhibiton- targets DNA gyrase

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14
Q

FQ toxicities

A

prolonged QT, nephrotoxicity (interstitial nephritis), tendon rupture

avoid in pregnancy if there is an alternative

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15
Q

FQ drug interactions

A

interact w/ NSAIDs- cause CNS problems like tremors, anxiety, insomnia, seizures

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16
Q

recommended first line B lactams to be given w/ macrolide)

A

penicillin (amoxicillin) or cephalosporins (ceftriaxone, cefpodoxime, cefuroxime)

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17
Q

B lactam toxicities (4)

A

Type I allergy (true allergy, IgE mediated): anaphylaxis, hypotension, bronchospasm, angioedema

Type II (IgG): slower, inflammation, urticaria, fever

Type IV: rare but could be fatal Stevens Johnson syndrome (toxic epidermal necrolysis)

nephrotoxicity (mostly penicilins, early cephalosporins)

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18
Q

worst B lactam for pregnancy

A

imipenem

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19
Q

rx for inpatient non ICU

A

FQ

or B lactam plus macrolide

20
Q

recommended B lactam inpatient non ICU

A

cefotaxime or ceftriaxone (IV/IM)

or ampicillin (IV/oral)

21
Q

rx for inpatient ICU

A

B lactam and azithromycin

or B lactam and FQ

both require B lactam

22
Q

B lactam moa

A

disrupt peptidoglycan in cell wall

23
Q

which 2 bugs must be covered in ICU?

A

strep pneumo and legionella

24
Q

which B lactam does not produce hypersensitivity

A

aztreonam

25
Q

ICU recommendations

A

Aztreonam + FQ has best evidence (avoids B lactam hypersensitivity)

26
Q

Rx when worried about pseudomonas or MRSA

A

for pseudomonas:
B lactam + FQ
or
B lactam + aminoglycoside + FQ

for MRSA: Vancomycin or linezolid

27
Q

recommended B lactams for pseudomonas

A

piperacillin +tazobactam

cefepime

imipenem/meropenem

28
Q

carbapenem toxicities

A

seizures- inhibit GABA receptors in brain (increased firing due to less hyperpolarization)

29
Q

anti pseudomonal FQ

A

levofloxacin

cipro is but not against strep pneumo so not used empirically

30
Q

aminoglycoside moa

A

inhibit 30S, selective for G-

31
Q

aminoglycoside toxicities

A

ototoxicity- damage hair cells, often permanent

nephrotoxicity (acute tubular injury to glomerulus, PCT, collecting duct)- usually reversible

32
Q

aminoglycoside and pregnancy

A

category D- not recommended

33
Q

vancomycin moa/ category

A

glycopeptide- disrupts cell wall

34
Q

linezolid moa/ category

A

oxazolienones- inhib 50S

35
Q

vancomycin toxicities

A

nephrotoxicity, ototoxicity

these are rare w/ vanc alone, should be avoided w/ other toxic drugs like aminoglycosides

Red man syndrome- mast cell histamine release
-can be avoided w/ diluted dose over an hour w/ antihistamines

36
Q

linezolid toxicities

A

myelosuppression and thrombocytopenia

37
Q

linezolid drug interaction

A

inhibit breakdown of serotonin- interact w/ SSRIs and can cause serotonin syndrome (fever, agitation, tremor, sweating)

38
Q

Rx w/ MSSA and Non MDR pseudomonas

A

piperacillin/tazobactam
cefepime
levofloxacin
imipenem or meropenem

anti pseudomonal and anti staph (G+)

39
Q

Rx w/ MRSA and non MDR pseudomonas

A

MRSA- Vanc or linezolid

antipseudomonal- 
piper/tazobactam
cefepime or ceftazidime
levofloxacin
imipenem or meropenem
aztreonam
40
Q

Rx for MSSA and MDR pseudomonas

A

B lactam anti pseudomonal (piper/tazo, cefipime or ceftazidime, imipenem or meropenem, aztreonam)

and non B lactam anti pseudomonal (levo, amikacin or gentamicin or tobramicin)

41
Q

rx for MRSA and MDR pseudomonas

A 
B lactam anti pseudomonal 
and
non B lactam anti pseudomonal (same list + maybe colistin)
and 
MRSA coverage w/ vanc and linezolin
42
Q

colistin moa

A

cell membrane inhibitor by binding to LPS

43
Q

colistin toxicities (3)

A

nephrotoxicity- mostly seen at high doses and not as bad as AGs

muscle weakness- interference w/ NMJ signaling

peripheral nerve damage, paresthesia

44
Q

clindamycin moa

A

50S inhib

45
Q

targets for clinda

A

G+ and G- anaerobes, esp for the aspiration pneumonias: bacteroides, prevotella, fusobacterium, peptostreptococcus

46
Q

clinda toxicities

A

pseudomembranous colitis

C diff superinfection

Respiratory Exam 2 (11 decks)

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