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Year 2 Resp Exam 2 > Antibiotics, J Kinder, Lec > Flashcards

Antibiotics, J Kinder, Lec Flashcards

1
Q

what patients do not fall into community acquired pneumonia Tx guidlines

A 
immunocompromised
solid organ bone marrow or stem cell transplant
chemo
long term high corticosteroids
congenital or acquire immunodeficiency
HIV
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2
Q

What is the evaluation of Illness severity Score

A 
CURB-65
Confusion
Uremia (BUN>19)
RR >30
BP SBP65)
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3
Q

if CRUB score is 0-1 how do you Tx

if score >3 how do you Tx

A

0-1: outpatient

>3: admit to ICU

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4
Q

What is minor mriteria for ICU admission

A

low WBC
low platelets
low core temperature

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5
Q

what are the absolute indications for ICU admission

A

mechanical ventilation

septic shock

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6
Q

What si required fro Dx CAP

A

demonstrable infiltrate on CXR

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7
Q

what are common bacteria causing CAP

A

Spneumonia
H influenza
Moraxella

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8
Q

What bacteria can you not pick up on a gram stain that cause CAP

A

mycoplasma pneumoniae
chlamydophila pneumoniae
legionella spp

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9
Q

most likley infecting organisms for outpatient

A 
s pneumoniae
mycoplasma pneumoniae
haemophilus i
chalmydophila pneumoniae
viral
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10
Q

what are common infecting organisms that we Tx inpatient non-ICU

A 
S pneumoniae
M pnuemonia
C pnuemonia
H influenzae
Legionell spp
Aspiration
Respiratory viruses
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11
Q

What are common infecting organisms for Px that we Tx in ICU

A 
S pneumoniae
S aureus
Legionella spp
Gram neg bacilli
H influenzae
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12
Q

What are pathogens that exist with chronic oral steroids or severe underlying bronchopulmonary disease, alcoholism, frequent antibiotic use

A

enterobacteriae

Pseudomonas aeruginosa

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13
Q

what are common viruses that cause CAP

A

influenza
RSV
adeno
parainfluenza

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14
Q

not so common viruses that can cause CAP

A

human metapneumovirus
HSV
Varicella zoster
SARS associated coronavirus

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15
Q

Drug Resistant S penumoniae is seen in what cases

A 
beta lactam use within previous 3 mo!!!
age 65 y.o
alcoholism
immunosuppresive illness or Tx
Exposure to child at day care
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16
Q

for a previously healthy Px what is outpatient Tx for CAP

A

macrolide (azithromycin PO)

Doxy PO

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17
Q

Outpatient recommendations for at risk DRSpneumo

A 
respiratory fluoroquinolones (levofloxacin)
Beta lactam PO (high dose amoxicillin, amoxicillin-clavulanate) alternates: (ceftriazone and cefurozime)
 \+ macrolide!!!
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18
Q

outpatient rec for Px in high rate (>25%)region of macrolid resistant S penumoniae

A

consider alternatives

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19
Q

What is rec for inpatient non ICU with CAP

A

Respiratory FQ IV or PO (levofloxacin)

Beta lactam IV (ceftriaxone)+ macrolide IV (azithromycin)

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20
Q

What is rec for inpatient ICU with CAP

A

B lactam IV (ceftriaxone) + azithromycin IV or Resp FQ (levofloxacin)

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21
Q

What is Tx for patient with beta lactam allergy

A

FQ

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22
Q

What are risk factors for pseudomonas

A

structural lung disease
repeated COPD exacerbations
prior antibiotic therapy

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23
Q

Tx for at risk pseudomonas CAP

A

anti-pseudomonal B lactam IV (piperacillin-tazobactam, cefepime) + cipro or levofloxacin

or B lactam + aminoglycoside (gentamycin and azithromysin)
or B lactam + aminoglycoside & anti-pseudomonal FQ

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24
Q

What are risks for CA-MRSA

A

end stage renal disease
injection drug abuse
prior influenza
prior antibiotic use (FQ)

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25
Q

Tx for MRSA

A

vancomycin IV or linezolid

panton-valentine leucocidin nectroizing pneumonia: add clindamycin or use linezolid

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26
Q

When do you switch from IV to oral

A

imrpoving clinically. hemodynamically stable
tolerating oral meds
normal functioning GI
normal mental status

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27
Q

Describe duration Tx for CAP

A

minimal 5 days
must be afebrile 48-72 hrs
no more than 1 CAP assoc sign

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28
Q

how long duration does pseudomonas

A

15 days

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29
Q

When does hospital acquired pneumonia begin

A

48 hrs after admission

increases length of stay 7-9 days

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30
Q

What is HCAP

A

health care associated penumonia

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31
Q

common hospital acquired pathofens

A

P aeruginosa, E coli, K pneumoniae, Acinetobacter Spp, MRSA

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32
Q

what are the oropharyngeal pathogens with hostpial acquired CAP

A

viridans group strepcocci
coagulase neg staphcocci
neisseria spp
corynebacterium spp

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33
Q

what can lead to pseudomonas R and what drugs is it becoming R to

A

mutlitple efflux pumps
decreased expression of outer membrane porin channel
piperacillin, ceftazidine, cefepime, imipenem, meropenem, aminoglycosides, FQs

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34
Q

What are the gram neg pathogens that are acquiring R and to what antibiotics

A

Klebsilla- ampicillin, cephalosporins and aztreonam

Enterobacter- cephalosporins

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35
Q

What does antibiotic carbapenem attack

A

the plasmid mediated AmpC-type enzymes (ESBL)

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36
Q

What is mech for MRSA

A

penecillin binding proteins have reduced affinity for B lactam
still R to linezolid, inc R is rare

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37
Q

What is mech behind DRSP

A

altered penicillin binding protein

still susceptible to vanco and linezolid

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38
Q

Dx for Drug Resistant CAP is what

A

radiographic infiltrate that is new or progressive

fever, purulent sputum, leukocytosis, decreased O2 sats

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39
Q

What is empiric Tx for early onset HAP

A

ceftiaxone OR FQ
OR ampicillin
or ertapenem

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40
Q

What are potential pathogens for late onset HAP

A

P aeruginosa
K pneumoniae
Acinetobacter
MRSA

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41
Q

Tx for late onset HAP

A 
Antipseudomonal cephalosporin
or
antipseudomonal carbapenem
or
B lactam + antispeudomonal FQ or aminoglycoside (gentamycin) 
\+ linezolid or vanco if think MRSA
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42
Q

What is drug of choice for non-resistant S pneumoniae

A

penicillin G, amoxicillin

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43
Q

What is drug of choice for resistant S pneumoniae

A

cefotaxime, ceftriaxone, levofloxacin, moxifloxacin, vanco, linezolid

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44
Q

What is drug of choice for H influenze

A

non B lactamase producing: amoxicillin

B lactamase producing: 2nd or 3rd generation cephalosproin, amoxicillin/cluvulanate

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45
Q

what is drug of choice for Mycoplasma pneumoniae or chlamydophila pneumoniae

A

Macrolide, tetracycline

46
Q

What is Drug of choice for legionella

A

FQ, azithro or doxy

47
Q

What is drug of choice for eneterboacteriae

A

3rd or 4th generation cephalosprin, carbapenem (if ESBL producer)

48
Q

what is drug of choice for pseudomonas

A

antispeudomonal B lactam + cipro or levo (FQ) or an aminoglycoside

49
Q

what is drug of choice for anaerobic pathogens like bacteroidesm fusobacterium and peptrostrep

A

B lactam/B lactamase inhibitor, clindamycin

50
Q

What is drug of choice for staph aureus

A

methicillin sensitive: penicillin (nafcillin, oxacillin, dicloxacillin)
methicillin R: vanco or linezolid

51
Q

adverse effect of clinda

A

diarrhea

52
Q

What is drug of choice foe pneumocystic jiroveci

A

trimethoprim/sulfamethoxazole

53
Q

Drug of choice for bordetella pertussis

A

azithromycin, clarithromycin

54
Q

what is drug of choice for influenza virus

A

oseltamivir, zanamivir

55
Q

What is drug of choice for coccidioides spp

A

no Tx necessary if normal host

otherwhise azoles

56
Q

Tx for histoplasmosis and blastomycosis

A

itraconazole

57
Q

Where can antibiotics target

A

cell wall synthesis, cell membrane synthesis
synthesis of 30S and 50S ribosomal subunits
nucleic acid metabolism
function of topoisomerases
folate synthesis

58
Q

How do beta lactams work

A

covalently bind penicillin binding proteins inhibiting the last transpeptidation step in cell wall synthesis

59
Q

what leads to beta lactam synthesis

A

structural differences in PBPs
decreased affinity
drug destruction and inactivation!!
active efflux pumps

60
Q

adverse effects penicillins

A 
allergic reactions
anaphylaxis
interstitial nephritis
nausea, vomiting, mild to severe diarrhea
Pseudomembranous colitis
61
Q

What are adverse effects cephalosproings

A

cross reactivity to penicillins
diarrhea
intolerance to alcohol

62
Q

adverse effects to carbapenems

A

nausea/vomiting
seizures
HS

63
Q

MOA vancomycin

A

binds terminal end of cell wall precursor units

64
Q

Resistant mech vanco

A

alteration ot D-Ala D ala target to something else so binds poorly

65
Q

Adverse effects to vanco

A

macular skin rash, chills, fever
red man syndrome (histamine release) extreme flushing, tachy and hypotension
ototoxicity, nephrotoxicity

66
Q

MOA FQ

A

concentration dependent that binds bacterial DNA gyrase and topoisomerase IV
prevents relaxation of + supercoils

67
Q

Resistant mech FQ

A

mutation in genes encoding DNA gyrase or topoisomerase IV

active transport out of cell

68
Q

adverse effects FQ

A

GI: nausea, vomiting, abdominal discomfort
CNS: mild HA, dizziness
rash photosensitivity, achilles tendon rupture (don’t give in children)

69
Q

What antibiotics inhibit 30S subunits

A

aminoglycosides and tetracyclines

70
Q

adverse effects aminoglycosides

A

ototoxicity, nephrotoxicity, NMJ toxicity

71
Q

adverse effects tetracyclines

A

GI, superinfecitons with C difficile
photosensitivity, teeth discoloration
do NOT give to peds

72
Q

What antibiotics inhibit 50S subunits

A

Macrolides
Clindamycin
Streptogramins
Linezolid

73
Q

What are adverse effects macrolides

A

GI, heptotoxicity, arrhythmias

74
Q

adverse effects clindamycin

A

diarrhea, C difficile, skin rash

75
Q

adverse effects streptogramins

A

infusion pain and phlebitis

76
Q

adverse effects linezolid

A

myelosuppression, HA, rash
anemia, thrombocytopenia
do NOT use with serotonin inhibitor usually

77
Q

How long is incubation for influenza

A

1-4 days

78
Q

When is viral shedding influenza

A

day after Sx 5-10 days after illness onset

79
Q

Sx influenza

A

abrubt

fever, myalgia, HA, malaise, non-productive cough, sore throat, rhinitis

80
Q

When do Sx resolve in influenza

A

3-7 days uncomplicated

cough and malaise can last >2 weeks

81
Q

the hemagglutin protein on virus binds what on cell lining

A

sialic acid

82
Q

What are the neurominidase inhibitors

A

oseltamivir PO and zanamivir INH

83
Q

How do neurominidase inhibitors work

A

analogs to sialic acid so interfere with release of influenza virus from infected host cell

84
Q

adverse effects oseltamivir

A

nausea, vomiting, abdominal pain, HA< fever, diarrhea, neuropsychiatric
approved for children >1 yr

85
Q

adverse effects zanamivir

A

cough, bronchospasm, dec pulm function, nasal throat discomfort, not rec in underlying resp disease
children >7 yrs

86
Q

How does R occur with neuroaminidase inhibitors

A

point mutation in viral hemagglutinin or neuraminidase surface proteins

87
Q

Tx use neurominidase inhibitors

A

influenza prophylaxis, influenza Tx

88
Q

What Tx influenza A

A

M2 channel blockers

amantadine PO and rimamtadine PO

89
Q

how do M2 Ch blocker work

A

block M2 proton ion channels or virus inhibiting uncoating of viral RNA within host cell

90
Q

adverse effects M2 ch blockers

A

GI, CNS dizziness, severe behavioral changes, delirium, agitation seizures from affect on dopamine transmission

91
Q

How does R to M2 Ch blockers occur

A

point mutations

92
Q

What antivirals are used for HSV and VZV

A

acyclovir (PO and IV and topical)

valacyclovir (PO)

93
Q

MOA of cyclovirs

A

3 phosphorylation steps for activation, first via virus specific thymidine kinase.
inhibit DNA synthesis
chain termination following incorporation into viral DNA

94
Q

What are the cyclovirs used to Tx

A

genital herpes, varicella, HSV encephalitis, neonatal HSV Tx

95
Q

adverse effects cyclovirs

A

nausea, diarrhea, HA

96
Q

What antivirals are used for CMV

A

ganiclovir and valganciclovir

97
Q

Hwo do the ciclovirs work

A

acyclic guanosine analog that requires activation by triphosphorylation before inhibiting DNA polymerase

98
Q

uses of the ciclovirs

A

CMV retinitis and CMV prophylaxis

99
Q

Adverse effects ciclovirs

A

myelosuppression, nausea, diarrhea, fever, peripheral neuropathy

100
Q

what are the fungi of clinical interest

A

candida albicans, histo capsulatum, crytpto neoformans, coccidioides immitis, aspergillus spp, blastomyces dermatitidis

101
Q

how do azole antifungals work

A

inhibit gunal cytocrhome P450 reducing the production of ergosterol

102
Q

what is ergosterol

A

cell membrane of fungi instead of cholesterol

103
Q

use azoles

A

wide spectrum fungi

104
Q

what are adverse effects azoles

A

minor GI upset, abnormalities in liver enymes

105
Q

major drug interactions of azoles

A

statins
anti convulsants
warfarin— bleeding!!

106
Q

adverse effects voriconazole

A

visual changes and photosensitivity

107
Q

What is amphotericin B

A

polyene macrolide antibiotic that binds ergosterol and puts pores in cell membrane

108
Q

Tx use amphotericin B

A

broadest epctrum used in life threatening infections

109
Q

adverse effects amphotericin B

A

infusion related fever, chills, vomiting, HA and cumulative toxicity in kidneys

110
Q

What are echinocandins

A

caspofungin, micagundin

inhibit synthesis B(1-3)glucan which disrupts fungal cell wall

111
Q

Tx use in echinocandins

A

candida and aspergillus, only IV

112
Q

adverse effect echinocandins

A

minor GI, flushing

Year 2 Resp Exam 2 (33 decks)

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