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Respiratory Week 1 > Antibiotics > Flashcards

Antibiotics Flashcards

1
Q

what are the four mechanism classes for bacterial pneumonia treatment?

A

DNA inhibs
Cell wall inhibs
protein synth inhib
cell membrane inhib

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2
Q

what is the initial treatment of pneumonia called?

A

empirical treatment

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3
Q

what are the three presentations of outpatient CAP?

A

healthy with no AB use within last 90 days
comorbidities or AB use in last 90 days
high rate of macro resistant of strep pneumo

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4
Q

how do you treat healthy with no AB use in last 90 day CAP?

A

macrolides

or doxycycline

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5
Q

name the three macrolides

A

azithromycin
erythromycin
clarithromycin

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6
Q

what is the mechanism of macrolides?

A

inhibits the 502 ribosomal subunit

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7
Q

which macrolide is not used much anymore and what are the two reasons why?

A

erythromycin…causes GI distress and not as effective against haemophilus

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8
Q

what is the cardiac toxicity of macrolides?

A

prolonged QT

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9
Q

macrolides target a certain molecule that leads to many drug interactions…what is this molecule?

A

CYP3A4…inhibition so increases effects of drugs cleared by it

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10
Q

what is the other positive effect macrolides have in treating pneuomonia?

A

it is also anti inflammatory

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11
Q

what are the two toxicities associated with doxycycline?

A

photosensitivity…UV light converts drug

teeth discoloration

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12
Q

should you give doxycycline during pregnancy? why or why not?

A

NO because of the changes it can have on teeth and bone

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13
Q

what age can you start giving doxycycline?

A

8 years of age

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14
Q

when should you take doxycycline?

A

significantly before or after eating food with di and trivalent ions…like calcium zinc magnesium

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15
Q

why do you have to be careful about when you take doxycycline?

A

because they can bind cations in digestive tract and it renders them unabsorbable

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16
Q

what are the two treatment options for CAP with comorbidities or antiobiotics in last 90 days?

A

fluoroquinolone
or
B lactam and macrolide

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17
Q

name the four fluoroquinolines, which is not effective against strep pneumo?

A

ciprofloxacin…this one is not used!!!
levofloxicin
moxifloxicin
gemifloxicin

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18
Q

name the cardiac toxicity associated with fluorquinolones

A

prolonged QT interval

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19
Q

where are fluorquinolones cleared what toxicity does this create?

A

renal…nephrotoxicity

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20
Q

what is the MSK toxicity associated with fluoroquinolones?

A

tendon rupture

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21
Q

what are the three very serious toxicities associated with fluorquinolones?

A

hypoglycemia causing coma
mental health effects
CNS effects like tremors anxiety insomnia seizures

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22
Q

if you combine fluoroquinolones with NSAIDS…whats the toxicity you can get?

A

CNS effects like tremors seizures anxiety insomnia

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23
Q

when choosing a beta lactam…what are the two classes you can choose from for pneumo?

A

penicillin

cephalosporins

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24
Q

what three types of sensitivity or allergic reaction can you have to b lactams?

A

type 1
type 2
type 4

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25
Q

what is the type IV allergic reaction to b lactams known as? what does it entail?

A

stephens johnson syndrome

toxic epidermal necrolysis

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26
Q

what antibody drives type I and type II reactions to b lactam?

A

IgE for I

IgG for II

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27
Q

if one is allergic to B lactams…what is the drug you use in place?

A

aztreonam

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28
Q

can you give b lactams during pregnancy?

A

yes

29
Q

for inpatient non icu CAP…what are your treatment options?

A

fluorquinolone
or
b lactam and macrolide

30
Q

if CAP turns into non icu inpatient…what species are we now adding to potential list?

A

legionella

31
Q

for CAP inpatient non icu…which classes of b lactams can you consider?

A

cephalosporins and penicillins

32
Q

for CAP ICU…what are your two treatment options?

A

b lactam and azithromycin
or
b lactam and fluoroquinolone

33
Q

what bacteria is now considered with ICU CAP?

A

staph A

34
Q

what organisms does aztreonam cover?

A

only gram negative…not gram positive

35
Q

which two bugs are of special concern in CAP?

A

MRSA

pseudomonas

36
Q

what are the two treatment options for CAP pseudomonas?

A

b lactam and fluoro
or
b lactam and aminoglycoside

37
Q

what are the two treatment options for CAP MRSA?

A

vancomycin
or
linozelid

38
Q

what is the CNS toxicity of carbapenems?

A

they inhibit GABA receptors in brain…leads to seizures

39
Q

which class of b lactams has seizure as toxicity?

A

carbapenems

40
Q

which fluoroquinolones can be used for pseudomonas?

A

ciprofloxacin and levofloxacin

41
Q

name the sensory toxicity of aminoglycosides?

A

ototoxicity…hearing loss

42
Q

which organ system can take a big hit when on aminoglycosides?

A

kidneys…nephrotoxicity

43
Q

name the two aminoglycoside toxicities

A

nephrotoxicity

ototoxicity

44
Q

what are the two toxicities of vancomycin?

A

nephrotoxicity

ototoxicity…maybe…we are not sure of this

45
Q

what is red man syndrome? what antibiotic is it associated with?

A

when histamines are released by mast cells non specifically

associated with vancomycin

46
Q

what is the toxicity associated with lenzolid?

A

myelosuppression…thrombocytopenia

47
Q

what drug class does linezolid interact with? what can this lead to?

A

SSRIs

leads to serotonin syndrome…

48
Q

what is serotonin syndrome? what are the symptoms?

A

high presence of serotonin in the brain…leads to fever agitation seizure tremors

49
Q

what are the two most relevant bugs in HAP and VAP?

A

pseudomona and staph aureus

50
Q

what is the preferred macrolide treatment for CAP with no AB use?

A

azithromycin

51
Q

what is the one scenarios in pneumonia that carbapenems are used or considered?

A

with pseudomonas coverage

52
Q

what four drugs to consider when treating MSSA and Non-MDR Pseudo?

A

piperacillin/tazobactam
cefepime
levofloxacin
impopenen/meropenem

53
Q

what drugs to give for MRSA and non-MDR pseudomonas?

A

vancomycin or linozelid

and one of:
piperacillin/tazobactam
cefepime
levofloxacin
impopenen/meropenem
54
Q

what drugs to give MSSA and MDR pseudomonas?

A 
b lactam anti pseudomonals
plus one of:
levafloxacin/ciprofloxacin
or
Amikacin/gentamicin/tobramycin
55
Q

what drugs to give with MRSA and MDR pseudo risk?

A

b lactam anti pseudomonals and non B lactam pseudomonals (Colistin) PLUS vancomycin or linezolid

56
Q

what is the drug colistin good at treating?

A

gram negative pseudomonas!!! drug resistant kind

57
Q

what is the mechanism of colistin?

A

disrupts outer and inner membrane of gram negative bacteria

58
Q

what are the three toxicities associated with colistin?

A

parasthesia
NMJ issues leading to muscle weakness
nephrotoxicity

59
Q

what drug is commonly given to treat aspiration pneumonia? why?

A

clindamycin….because it is good at treating anaerobic bacteria

60
Q

what is the toxicity of clindamycin?

A

pseudomembranous colitis…c diff super infection

61
Q

name the B lactam anti pseudomonals

A

piperacillin/tazobactam
cefepime/ceftazidime
Imipenen/meropenem
Aztreonam

62
Q

name the non b lactam anti pseudomonals

A

levofloxacin/ciprofloxacin
amikacin/gentamicin/tobramycin
colistin

63
Q

name the two fluoroquinolones that fight pseudomonas

A

levofloxacin and ciprofloxacin

64
Q

name the monobactam B lactam that fights pseudomonas

A

aztreonam

65
Q

name the carbapenem beta lactams that fight pseudomonas

A

imipenem

meropenem

66
Q

name the cephalosporin beta lactams that fight pseudomonas

A

ceftazidime and cefepime

67
Q

name the one broad spectrum b lactam that fights pseudomonas

A

piperacillin

68
Q

name the three aminoglycosides that fight pseudomonas

A

gentamicin
tobramycin
amikacin

Respiratory Week 1 (18 decks)

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