drugs for CAH HAP and VAP

Question 1

What to treat Viral pneumonia with ?

Answer 1

Influenza: get the annual flu vaccine

Oseltamivir, zanamivir

• Neuraminidase inhibitor
• effective against inf A and B
• tage within first 48 hrs of symptoms

Question 2

is there a vaccine or streptococcus pneumoniae and who is it recommended for?

Answer 2

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

Question 3

what to treat community acquired pneumonia with? and what are the toxicites and MOA

Answer 3

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

Question 4

what to use in community acquired pneumonia and hospital acquired or ventilator associated pneumonia? and what are toxicities and MOA

Answer 4

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

Question 5

what are pencillinase resistant penicillins

Answer 5

nafcillin used against some staph aureus strains

Question 6

what is noteworthy about ceftriaxone

Answer 6

not eliminated by the kidney and does not need the dosage adjustment for renal impairment

Question 7

what are two parenteral cephalosporins?

Answer 7

Ceftriaxone

cefepime

Question 8

what are three oral cephalosporins

Answer 8

Cefditoren
cefpodoxim
e-proxetil

Question 9

Cefpodxime and cefditoren MOA effects and Clinical applications

Answer 9

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

Question 10

what are Tetracycline Indications and MOA

Answer 10

MOA: binds 30s unit and kills bacteria lacking cell walls especially mycoplasma pneumonia

Indications: Community acquired pneumonia
-doxycycline

Question 11

Tetracycline side effects!?

Answer 11

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

Question 12

what are common macrolides and what are their MOA

Answer 12

erythromycin, clarithromycin, azithromycin

affects the 50s subunit and block peptide chain elongation

Question 13

what are the bacterias that Macrolides attack

Answer 13

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

Question 14

things to remember with erythromycin, clarithromycin, azithromycin

Answer 14

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

Question 15

MOA and use of Respiratory Fluoroquinolone

Answer 15

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

Question 16

Side effets of Fluoroquinolones

Answer 16

degeneration of tendons especially achilles tendon (cause rupture)

can cause GI upset and photosensitivity

Question 17

what is Vancomycin used for and what are some side effects

Answer 17

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

Question 18

what are the use of Pleuromutilins

Answer 18

Lefamulin, IV

given for CAP with normal lungs and works when others done

-prevents bacterial translation

Question 19

what does ciprofloxacin inhibit?

Answer 19

DNA gyrase inhibition

and is important for killing gram negative bacteria especially pseudomonas

Question 20

Linezolid MOA, effects and CA, PK, and Toxicities

Answer 20

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

Question 21

Aztreonam MOA, Effects, CA, PK, Toxicities

Answer 21

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

Question 22

Imipenem: MOA, Effects, CA, PK, and toxicities

Answer 22

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

Question 23

MOA, effects, and clinical applications, PK and Toxicities of GEntamicin

Answer 23

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

Question 24

If a patient has C diff what is one drug that could lead to this?

Answer 24

CLindamycin