drugs for CAH HAP and VAP Flashcards
What to treat Viral pneumonia with ?
Influenza: get the annual flu vaccine
Oseltamivir, zanamivir
- Neuraminidase inhibitor
- effective against inf A and B
- tage within first 48 hrs of symptoms
is there a vaccine or streptococcus pneumoniae and who is it recommended for?
yes!
•
all adults ≥ 65 yrs old
•
people 2 -64 yrs old if immunocompromised
•
adults 19 -64 yrs old who smoke cigarettes
•
single shot re-administered every ~5 yrs once started
what to treat community acquired pneumonia with? and what are the toxicites and MOA
Amoxicillin and Clavulanate
amoxicillin: inhibits cell wall synthesis
clavulanate: inhibits beta lactmases
effects:
- covers Gram positive and Gram negative
- not pseudomonas
given: oral
Toxicities:
-dont use in infectious Mononucleosis
what to use in community acquired pneumonia and hospital acquired or ventilator associated pneumonia? and what are toxicities and MOA
Piperacillin and tazobactam
Piperacillin: inhibits cell wall synthesis (PBP)
Tazobactam: inhibits beta lactamases
Effects:
- covers gram positive and negative aerobic and anaerobic
- covers pseudomonas as well
-given IV
Toxicites:
- hypersensitivity
- steven johnson syndrome
- nephrotoxicity
what are pencillinase resistant penicillins
nafcillin used against some staph aureus strains
what is noteworthy about ceftriaxone
not eliminated by the kidney and does not need the dosage adjustment for renal impairment
what are two parenteral cephalosporins?
Ceftriaxone
cefepime
what are three oral cephalosporins
Cefditoren
cefpodoxim
e-proxetil
Cefpodxime and cefditoren MOA effects and Clinical applications
MOA: inhibits cell wall synthesis via PBP
Effects: Gram positive and Gram negative bacteria
Cefpodoxime:
- COPD
- CAP
- Strep group A
- UTI
- Otitis media
Cefditoren
- CAP
- Acute bronchitis exacerbation
PK: both oral
-eliminated via kidneys
Toxicities:
-beta lactam allergy
what are Tetracycline Indications and MOA
MOA: binds 30s unit and kills bacteria lacking cell walls especially mycoplasma pneumonia
Indications: Community acquired pneumonia
-doxycycline
Tetracycline side effects!?
Dont use in young kids as developing permanent teeth will be stained
- cause esophageal irritation and ulceration
- Photosensitivity
- do not use with bactericidial drugs like penicillins
what are common macrolides and what are their MOA
erythromycin, clarithromycin, azithromycin
affects the 50s subunit and block peptide chain elongation
what are the bacterias that Macrolides attack
Community acquired pneumonia
aerobic and anaerobic gram positive microorganisms: beta hemolytic streptococci, pneumococci, staphylococci, and enterococci
gram negative bacteria: Pasteurella, haemophilus and neiseria
effective against legionella pneumophila, mycoplasma, mycobacteria and rikettsia and chlamydia
things to remember with erythromycin, clarithromycin, azithromycin
erythromycin: cause epigastric pain if not taken with food
- inhibits cP450
clarithromycin:
-less GI upset but is cP450 inhibitor
azithromycin:
- does not effect cP450
- long half life
MOA and use of Respiratory Fluoroquinolone
Levofloxacin, gemifloxacin, moxifloxacin
- Gram positive organisms
- inhibits TopoIV
- given orally
More effective then tetracyclines or macrolides for pneumonia but should be reserved
- comorbid conditions
- recent antimicrobial use
- good against strep pneumoniae
Side effets of Fluoroquinolones
degeneration of tendons especially achilles tendon (cause rupture)
can cause GI upset and photosensitivity
what is Vancomycin used for and what are some side effects
MOA: binds to the D-ala-D ala portion of the cell wall during synthesis
Given IV for MRSA and MRSE
used to treat C difficile colitis via oral tablet
Infusing too fast can cause Red man syndrome
what are the use of Pleuromutilins
Lefamulin, IV
given for CAP with normal lungs and works when others done
-prevents bacterial translation
what does ciprofloxacin inhibit?
DNA gyrase inhibition
and is important for killing gram negative bacteria especially pseudomonas
Linezolid MOA, effects and CA, PK, and Toxicities
MOA: inhibit the ribosomal A site of 50s subunit to prevent t RNA binding
Effects: Gram positive bacteria
- streptoccci
- VRE
- MRSA
CA: treat CAP, HAP, and VRE
PK: oral or IV
Toxicities:
- lactic acidosis
- thrombocytopenia
- peripheral and optic neuropathy
- serotonin syndrome
- hypoglycemic
Aztreonam MOA, Effects, CA, PK, Toxicities
MOA: inhibiys cell wall by binding to PBP
Effects: Gram negative aerobic pathogens including Pseudomonas aeurginosa
CA: Gram negative Bacilli
PK: IM or IV
-hypersensitivity
Imipenem: MOA, Effects, CA, PK, and toxicities
MOA: inhibits bacterial cell wall synthesis of PBPS
Effects: wide spectrum of gram negative and gram positive aerobic and anerobic bacteria
-active against many multiresistant strains
CA: Lower respiratory tract infections
PK: IV
Toxicities:
- CNS affects
- hypersensitivity
MOA, effects, and clinical applications, PK and Toxicities of GEntamicin
MOA: binding to 30s ribosomal subunit
Effects: Gram negative bacteria, Pseudomonas, proteus, E Coli, klebsiella, Enterobacter, aerogenes, serratia
-Gram Positive staphylococcus
CA: Respiratory tract infections
PK: given IV or IM
-requires monitoring
Toxicities:
- Hypersensitivity
- Nephrotoxicity
- Nuerotoxicity
- Ototoxicity
If a patient has C diff what is one drug that could lead to this?
CLindamycin
