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Pulmonary Week 2 > Bacterial Infections of the Lung > Flashcards

Bacterial Infections of the Lung Flashcards

1
Q

Pneumonia is infection of what part of the RT?

A

lower (respiratory bronchioles, alveoli)

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2
Q

What are the symptoms of pneumonia?

A
  • FEVER, cough, and sputum production
  • Dyspnea
  • Chest infiltrates
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3
Q

THE most important factor in successful pneumonia treatment is what?

A

EARLY intervention, cultures from blood and sputum to

identify the infective organism can be obtained after beginning broad, empiric treatment

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4
Q

What is the most likely cause of community acquired pneumonia (CAP) in patients 0-6 weeks of age?

A

Group B strep or E. Coli

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5
Q

What is the most likely cause of community acquired pneumonia (CAP) in patients 6 weeks to 18 years of age?

A

Viruses, Mycoplasma pneumoniae, Chlamydia pneumoniae,

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6
Q

What is the most likely cause of community acquired pneumonia (CAP) in patients 18-40 years of age?

A

Mycoplasma pneumoniae, Strep pneumo

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7
Q

What is the most likely cause of community acquired pneumonia (CAP) in patients 40-65 years of age?

A

Strep pneumo, Haemophilus influenzae, anaerobes and viruses,

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8
Q

What is the most likely cause of community acquired pneumonia (CAP) in patients over 65 years of age?

A

Strep pneumo, viruses, anaerobes

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9
Q

What is the most likely cause of nosocomial pneumonia?

A

Staph aureus or Pseudomonas aeruginosa

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10
Q

Alcohol use attenuates lung function. How?

A

Chronic alcohol drinkers have decreased

saliva production, an important component of mucosal defense.

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11
Q

Diabetes also increases the risk of pneumonia. How?

A

Possibly because the disorder neutralizes the effects of protective proteins on the surface of
the lungs.

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12
Q

What is the most likely cause of pneumonia in diabetics or alcoholics?

A

Klebsiella

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13
Q

Immunodeficient patients are at risk of infection from what organisms?

A
  • CMV

- Aspergillus and Pneumocystis

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14
Q

Describe Legionalle Pneumophilia

A

a gram negative aerobe that thrives in aquatic environment and loves water between 25-42 C

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15
Q

What patient population is most at risk for pneumonia caused by legionella (Legionnaires Disease)?

A
  • Men over 50
  • Smokers or those with COPD
  • Immunocompromised
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16
Q

What is commonly used to treat legionnaires pneumonia?

A
  • erythromycin
  • azithromycin
  • “respiratory” quinolone”

These drugs have good dosing characteristics and the advantage of easily
achieving good conc. in pulmonary tissues.

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17
Q

What are some ‘respiratory’ quinolones?

A

-levofloxacin, cipro, or moxifloxacin

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18
Q

What is a major possible DD interaction in patients taking macrolides?

A

rifampin

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19
Q

What is the DOC for outpatient CAPs with no modifying factors?

A

any macrolide or doxycycline

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20
Q

What is the DOC for outpatient CAPs with COPD who HAVE taken steroids or antibiotics in the past 3 months ?

A

Fluoroquinolone or amox/clav or clarithromycin +- cephalosporin

same for a nursing home patient

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21
Q

What is the DOC for outpatient CAPs with COPD who HAVE NOT taken steroids or antibiotics in the past 3 months ?

A

clarithromycin or doxycycline

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22
Q

What is the DOC for hospital ward CAPs?

A

fluroquinoline or amox/clav or clarithro/azithromycin +- cephalosporin

23
Q

What is the DOC for ICU CAPs?

A

3rd gen cephalosporin +- macrolide or piperacillin/tazo or fluoroquinolone

24
Q

What is the DOC for ICU CAPs with a risk of P. aeruginosa?

A

ciprofloxacin + B-lactam OR

macrolide + (amino, ceftazidime, cefepime, meropenem, or piper/taz)

25
Q

In nocosomial pneumonia, vanco is reserved for what?

A

MRSA

26
Q

Gram+ cocci being the cause of nocosomial pneumonia is more common in what patients?

A
  • ICU
  • DM
  • Head trauma
27
Q

What are the DOC for nocosomial pneumonia?

A
  • Imipenem/Cilastin
  • Aztreonam
  • Ceftazidime (Cefepime)
  • Vanco (poor bioavailability, give IV)
28
Q

What is aspiration pneumonia?

A

When aspiration of gastric acid, a foreign body or normal oropharyngeal secretions give rise to pneumonia

29
Q

When are oropharyngeal secretions most likely to cause aspiration pneumonia?

A

in reduced consciousness and long term intubation

30
Q

Most of the causative organisms for aspiration pneumonia are ____

A

gram negative enteric bacilli (50%), then anaerobes and S. aureus

31
Q

What is the DOC for aspiration pneumonia?

A

clindamycin or ampicillin/sulbactam

32
Q

How does clindamycin work?

A

50s ribosomal inhibitor blocking translocation

33
Q

What are some situations in which PO administration would not be best?

A
  • presence of food or other chelating drugs in GI

- Hypotension shunts blood away from GI

34
Q

What does ‘concentration dependence’ mean in terms of drugs?

A

bacterial death is proportional to conc (i.e. fluoroquinolone or aminoglycosides), whereas time-dependent antibiotics are dependent on duration in serum (B-lactams)

35
Q

How are conc dependent drugs given?

A

these are often given in large doses (relative to the MIC) at long intervals relative to the serum half life for the agent.

36
Q

How are time dependent antibiotics given?

A

usually dosed more frequently, with an emphasis
on the need to maintain the serum drug level above the MIC for 30-50% of the dose
interval.

37
Q

Which drugs are not predominantly renally eliminated?

A
  • azithromycin/erythromycin
  • ceftriaxone
  • clindamycin
  • doxycycline
  • linezolid
38
Q

What are some AEs of doxycycline?

A
  • teeth discolorization
  • photosensitivity
  • stunted bone growth
39
Q

What are some AEs of vance?

A

nephro and ototoxicity and Red Man’s syndrome

40
Q

What are some AEs of levofloxacin?

A

-tendon rupture in adults and cartilage damage in young children

41
Q

What are some AEs of erythromycin?

A
  • CYP3A4/Pgp inhibitor
  • Jaundice
  • QT prolongation
42
Q

What are some AEs of gentamicin?

A

nephro and ototoxicity and neuromuscular paralysis

43
Q

What are some AEs of linezolid?

A
  • bone marrow suppression

- non-specific MAO inhibitor

44
Q

What is the rational of adding clavulanic acid to amoxicillin, tazobactam to piperacillin, and sulbactam to ampicillin?

A

the are irreversible inhibitors of bacterial beta-lactamases

45
Q

Why is cilastin given with Imipenem?

A

it is a reversible, competitive inhibitor of renal dehydroepeptidase-1 (DHP-1), which breaks down Imipenem to NEPHROtoxic metabolites

46
Q

Why is Daptomycin not used to treat pneumonia even though it has greater activity than vance vs. some gram positive organisms?

A

The drug activity is directly inhibited by the presence of pulmonary surfactants.

47
Q

What are the most common causes of bronchitis in young patients?

A

viral

48
Q

What is the most common causes of bronchitis in smokers?

A

H. influenzae

49
Q

What is the most common causes of bronchitis in elderly patients with comorbidites?

A

bacterial (mycoplasma pneumoniae, Strep pneumo, H. influenzae)

50
Q

DOC for bronchitis?

A
  • amoxi/clav
  • azithro/clarithro
  • doxycycline
51
Q

DOC for resistant bronchitis?

A

Cipro

52
Q

How is lung abscess treated?

A

Treatment initially involves IV drug therapy with transition to an 2 month oral regimen after a couple of weeks.

53
Q

DOC for lung abscess?

A

Although penicillin has been considered as the drug of choice, clindamycin has proven superior, primarily because of the emergence of penicillin-resistant Bacteroides.

54
Q

Other drug choices for lung abscess?

A

Metronidazole should not be used alone due to incomplete coverage, but may be used with a third generation cephalosporin for nocosomial infection

Pulmonary Week 2 (25 decks)

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