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Pulmonology > Bacterial Infections of the Lung- Sweatman > Flashcards

Bacterial Infections of the Lung- Sweatman Flashcards

1
Q

Most important factor in successful treatment of pneumonia?

A

Early intervention

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2
Q

What are you thinking in a patient with pneumonia symptoms and an unproductive cough?

A

Mycoplasma or viral pneumonia

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3
Q

What are the respiratory quinolones?

A

Levofloxacin, ciprofloxacin, and moxifloxacin

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4
Q

Macrolides commonly used in respiratory infections?

A

Erythromycin, Azithromycin

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5
Q

Risk factors for contracting Leginonnaires Disease?

A

1) Male sex and >50 years of age
2) Smokers or those with chronic lung disease
3) Immunocompromised

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6
Q

Possible abx for HAP (6)?

A

1) Imipenem/Cilistatin
2) Meropenem (alternate for Imipenem)
3) Aztreonam
4) Piperacillin/Tazobactam (alt)
5) Ceftazidime
6) Cefepime (alt)

all these offer coverage against Gram(-) anaerboes; most likely Pseudomonas or Haemophilus

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7
Q

When is vancomycin used to treat HAP?

A

MRSA

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8
Q

Antibiotics recommended for aspirational pneumonia?

A

Clindamycin or Ampicillin/Sulbactam; coverage for gram negative anaerobes

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9
Q

Unique toxicities of Azithromycin?

A

Cholestatic jaundice; QT prolongation

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10
Q

Unique toxicities of Doxycycline?

A

Teeth discoloration; photosensitivity; retards bone growth

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11
Q

Unique toxicities of Erythromycin?

A

CYP3A4/Pgp Inhibitor; cholestatic jaundice; QT prolongation

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12
Q

Unique toxicities of Gentamicin?

A

Nephrotoxic and ototoxic; neuromuscular paralysis

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13
Q

Unique toxicity of Imipenem?

A

Seizures

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14
Q

Unique toxicities of Levofloxacin?

A

Tendon rupture (adults); cartilage damage (children)

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15
Q

Unique toxicities of Linezolid?

A

Bone marrow suppression; non-specific MAO inhibitor

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16
Q

Unique toxicities of Vancomycin?

A

Nephrotoxicity and ototoxicity; Red Man’s Syndrome (erythematous rash over face, neck, and upper torso after infusion –> mast cell degranulation)

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17
Q

Daptomycin is not used to treat pneumonia despite having great activity against Gram(+), better than vanc. Why?

A

Because it is directly inactivated by pulmonary surfactant

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18
Q

Indicated treatment of bronchitis (no resistance)?

A

Amoxicillin+Clavulanic Acid; Azithromycin; Clarithromycin; Doxycycline

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19
Q

Indicated treatment for bronchitis with resistance?

A

Ciprofloxacin

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20
Q

Indicated treatment for Lung Abscesses?

A

Clindamycin (covers PCN-resistant bacteriodes); Metronidazole + Ceftriaxone (Nosocomial infections); metronidazole should not be used alone due to incomplete coverage

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21
Q

What is the most common cause of CAP pneumonia in pts age 40+

A

Strep pneumo

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22
Q

what is the most common cause of CAP pneumonia in adolescents

A

Mycoplasma p

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23
Q

what is the most common cause of CAP pneumonia in pts 0-6 weeks old

A

Group B streptococci

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24
Q

What are the most likely organisms involved in nosocomial pneumonia

A

S. aureus, P. aeuruginosa

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25
Q

If you see an alcoholic or a diabetic, what kind of pneumonia are you thinking?

A

Klebsiella

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26
Q

why are chronic alcohol users at risk for severe CAP?

A

they have decreased saliva production, an important component of mucosal defense

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27
Q

why do diabetics face a higher risk for influenza and its complications?

A

possibly b/c diabetes neutralizes the effects of protective proteins on the surface of the lungs

28
Q

what is the only drug on label for the treatment of legionella?

A

erythromycin - 1st gen macrolide

29
Q

what are the Abx most commonly used by physicians for the tx of Legionella (the technically not labeled ones)

A

a newer macrolide - azithromycin (3rd gen)

“respiratory” quinolones - levofloxacin, cirpofloxacin, moxifloxacin

30
Q

what is the advantage of using newer macrolides or respiratory quinolones in the tx of Legionellas?

A

these drugs have good dosing characteristics and the advantage of easily achieving good concentrations in pulmonary tissues

31
Q

for a severly ill pt w/ Legionellas, what drug can you add in in combination? what is a potential problem?

A

Rifampin

potential for drug-drug interactions (CYP) of rifampin and macrolide w/ pt concurrent drugs is constant problem

32
Q

decision tree for drug selection in the tx of CAP - if you have an outpatient with no modifying factors - what drugs?

A

macrolide or doxycyline

33
Q

decision tree for drug selection in the tx of CAP - if you have an outpatient with COPD, what drug history do you need to obtain before proceeding with treatment?

A

steroid or Abx in the past 3 months

34
Q

decision tree for drug selection in the tx of CAP - outpt w/ COPD who has not been on steroid or Abx in past 3 months - what drugs can you use?

A

2nd gen macrolide (clarithromycin) or doxycycline

35
Q

decision tree for drug selection in the tx of CAP - outpt w/ COPD who has a history of steroid or abx in past 3 months - what drugs

A

Fluoroquinolone;
amox/clav;
2nd gen macrolide +- cephalosporin

36
Q

decision tree for drug selection in the tx of CAP - if you are treating a nursing home pt, what drugs?

A

Fluoroquinolone;
amox/clav;
2nd gen macrolide +- cephalosporin

37
Q

decision tree for drug selection in the tx of CAP - treating a pt on the hospital ward - what drugs

A

Fluoroquinolone;
amox/clav;
2nd or 3rd generation macrolide +- cephalosporin

38
Q

decision tree for drug selection in the tx of CAP - pt in the ICU - what drugs

A

3rd gen Cephalosporin +- macrolide;
piperacillin/tazobactam;
fluoroquinolone

39
Q

decision tree for drug selection in the tx of CAP - pt in the ICU that is at risk of P aeruginosa - what drugs

A

1) antipseudomonal fluoroquinolone (cipro) + B-lactam (ceftazadime, meropenem, or piperacillin/tazobactam)
2) macrolide + 2 antipseudomonal agents (aminoglycosides + ceftazadime, cefepime, meropenem, or pip/taz)
aminoglycoside = gentamicin

40
Q

What are the 1st, 2nd, and 3rd gen macrolides?

A

1st - erythromycin
2nd - clarithromycin
3rd - azithromycin
(go in descending order alphabetically)

41
Q

what is the MOA of macrolides?

A

50s ribosomal inhibitor blocking translocation

42
Q

what is an example of a tetracyline and their MOA?

A

Doxycyline

30s ribosomal inhibitor blocking protein synthesis

43
Q

what is the most commonly used Fluoroquinolone and the MOA?

A

Levofloxacin

DNA gyrase inhibitor preventing DNA replication

44
Q

what are the two most commonly used Penicillins and the MOA?

A

Amoxicillin+ Clav
Pip/Taz
block cell wall cross-linking

45
Q

what is the most commonly used carbopenem and the MOA

A

Meropenem

blocks cell wall cross-linking

46
Q

what are the 1st, 2nd, 3rd gen cephalosporins most commonly used? what are the 3rd gen cephs w/ antipseudomonal activity?

A

1st - cefazolin
2nd - cefuroxime
3rd - ceftriaxone (tri)
3rd w/ antipsuedo - ceftazadime or cefepime

47
Q

MOA of cephalosporins?

A

inhibition of cell wall cross-linking

48
Q

the most common aminoglycoside and MOA

A

Gentamicin

30s ribosomal inhibitor

49
Q

what is the mechanism of resistance to macrolides?

A

ribosomal methylation and mutation of 23S rRNA

active efflux

50
Q

what is the mechanism of resistance to tetracyclines

A

decreased entry into and increased efflux from

target insensitivity

51
Q

what is the mech of resistance to fluoroquinolones

A

mutation of DNA gyrase

active efflux

52
Q

what is the mech of resistance to penicillins?

A 
drug inactivation (B-lactamase) 
altered PBPs (target insensitivity)
53
Q

what is the mech of resistance to cephalosporins?

A

decreased permeability of gram -ve outer membrane (altered porins)
active efflux

54
Q

what is the mech of resistance to aminoglycosides?

A

drug inactivation (aminoglycoside modifying enzyme)
decreased permeability of gram -ve outer membrane
active efflux
ribosomal methylation

55
Q

what is the MOA of clindamycin

A

50S ribosomal inhibitor blocking translocation

56
Q

what is the mech of resistance towards clindamycin?

A

methylation of binding site, enzymatic inactivation

57
Q

what is the MOA of vancomycin?

A

binds D-alanyl-D-alanine terminus of the peptide precursor units, inhibiting peptidoglycan polymerase and transpeptidation reactions

58
Q

what is the mech of resistance towards vanc?

A

replacement of D-ala by D-lactate

59
Q

why is cefepime considered to be a 4th generation cephalosporin?

A

it retains activity against some microbes that demonstrate resistance to ceftazidime

60
Q

what are the 6 abx that do not need a dose adjustment for the renally impaired? in other words, what 6 Abx are not excreted solely by the renal route?

A 
Azithromycin 
Ceftriaxone 
Clindamycin 
Doxycyline 
Erythromycin 
Linezolid
61
Q

if a pt shows a prior allergic rxn to penicillin, what other drug classes should you be weary of? why?

A

cephalosporins
carbapenems
they all contain a B lactam ring - cross reactivity

62
Q

What 4 abx do you need to use caution/avoid in a breastfeeding mother?

A

Piperacillin
Metronidazole (avoid)
Clarithromycin
Linezolid

“Pregnant Mothers Cannot Lactate”
or some other shitty mnemonic that helps you remember this fucking shit

63
Q

What are the 4 combination drug products for abx?

what is the rationale?

A

1) Amox/Clav
2) Pip/Tazobactam
3) Ampicillin/Sulbactam
4) Imipenem/Cilastin

none of the additives possesses any antimicrobial activity, rather these are metabolic inhibitors that preserve the lifespan of the drug and therefore its activity

64
Q

what 2 drugs are an appropriate 1st choice for CAP? what is another option?

A

1) macrolide (azithromycin)
2) respiratory quinolone (levofloxacin)
3) Amox/clav

65
Q

what should treatment for abscess and spiration pneumonia cover?

A

oral anaerobes

Pulmonology (31 decks)

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