CIS Pharm of resp infections Flashcards
basic MOA’s
spectrum of activity
notable resistance patterns
common/important side effects
list the antibiotic treatments recommended by current guidelines for initial empiric treatment of CAP for: -outpatients inpatients -ICU -another
know it!
what are the resp fluoroquinolones
ciprofloxacin
-variable to s. pneumonia
levofloxacin
-suscept to s. pneumonia
moxifloxacin
-suscept to s. pneumoniae
for HAP when we are worried about pseudomonas–> cipro is most effective against this bacteria
levofloxacin –> use if concerned for multiple organsims causing resp infections
chloramphericol
last line antibiotic
causes adverse effects
MOA: inhibits protein synthesis
translation and the protein synthesis inhibitors ….
binding to P site first - both subunits come together and initiate protein synthesis
- aminoglycosides 30S
- Linezolid 50S
tRNA brings AA’s to ribosomes to form proteins
- Tetracylines (30S)
- streptogrammins (50S)
translocation
-Macrolides 50S
Clindamycin 50S
peptide elongation
protein synthesis
56 year old male
primary care with fever, chills, productive cough
sputum shows gram positive diplococci
what is the most common identified pathogen in community acquired pneumonia?
most common–> strep pneumoniae
what drug works most appropriate for strep pneumoniae
sputum
gram positive diplococci
outpatient recommendations
in previously healthy???
At risk for DRSP
comorbidities,age >65
use of antimicrobials within 3 months???
Previously healthy:
Macrolide (azithromycin)
Doxycycline
At risk for DRSP:
Respiratory fluoroquinolone PO (levofloxacin, moxifloxacin, gemifloxacin)
B-lactam PO [high dose amoxicillin or amoxicillin-clavulanate preferred (alternates: ceftriaxone, cefuroxime)] PLUS a macrolide PO
drugs of choice for strep pneumo
Penicillin G
Amoxicillin
MOA of azithromycin
blocks protein synthesis by inhibiting translocation
50S
micro report indicates that the pathogen is strep pneumoniae with high level resistance to penicillin. what would you treat?
levofloxacin
what is the mechanism of resistance of strep pneumoniae ? (resistance to penicillin)
alteration of the penicillin binding protein
what organism would be seen in a patient on a cruise recently or in a hotel….
legionella
68 year old female
two day history of productive cough and fever
she complains of SOB and sharp pains in her chest when she breathes in deeply
3 weeks ago treated for resp infection
left lower lobe infiltrate
sats 88%
RR 32
age 68
what is her CURB 65
CURB-65 Confusion Uremia (BUN > 19 mg/dL) Respiratory rate (≥ 30 breaths/min) Low blood pressure SBP 3 admit to ICU
beta lactamases are more thought of in what bacteria
staph aureus
patient is admitted to the hospital with CAP. which of the following is most appropriate?
she was recently on cipro
ceftriaxone plus azithromycin (b/c she had cipro recently) so we need to use something with a different MOA
Inpatient, non-ICU:
Respiratory FQ IV or PO (levofloxacin)
B-lactam IV (ceftriaxone) PLUS macrolide IV (azithromycin)
Inpatient, ICU
B-lactam IV (ceftriaxone, cefotaxime, or ampicillin/sulbactam preferred) PLUS azithromycin IV OR a respiratory FQ (levofloxacin, moxifloxacin)
For our ICU patients that are admitted that have previous anaphylaxis to penicillin is an indication to use….
aztreonam
doesn’t show cross reactivity with other B-lactam antibiotics
which is routinely monitored during antibiotic therapy to determine response….
temp- 90
Arterial O2 sats >90
Ability to maintain oral intake
normal mental status
CXR lag behind in improvement by about 3 weeks so doesn’t help determine improvement
