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Resp II > Drugs for respiratory infections > Flashcards

Drugs for respiratory infections Flashcards

1
Q

CURB-65

A

confusion
uremia (BUN>19)
respiratory rate (>=30)
BP low (systolic =65

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2
Q

CURB-65 scale

A

0-1 treat outpatient
2-admit
3-ICU

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3
Q

minor criteria of admission

A

WBC100,000

temp <36

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4
Q

absolute indications for ICU admission

A

mechanical ventilation

septic shock

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5
Q

CAP CXR

A

infiltates required for Dx

if neg but CAP strongly suspected start antibiotics and repeat CXR in 24-48hrs

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6
Q

CAP culutre

A

need to know what microbe to Tx to decrease mortality

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7
Q

CAP UA

A

legionella

pneumococcal

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8
Q

atypical bacteria

A

mycoplasma penumoniae
chlamydophilia pneumoniae
legionella

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9
Q

common infecting organisms for outpatient

A 
S. penumoniae
M. pneumoniae
H. influenza
Chlamydophilia pneumoniae
respiratory viruses
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10
Q

in-patient non ICU organisms

A 
S. penumoniae
M. pneumoniae
Chlamydophilia pneumoniae
H. influenza
legionella
aspiration
respiratory viruses
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11
Q

ICU organisms

A 
S. penumoniae
S. aureus
legionella
gram - bacilli
H. influenza
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12
Q

underlying bronchopulmonary disease

A

H. influenza
M. catarrhalis
S. aureus

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13
Q

chronic oral steriods, severe underlying bronchopulmonary disease, alcoholism, frequent antibiotic use

A

enterobacteriaceae

pseudomonas aeruginosa

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14
Q

anaerboes

A

classic aspirations in alcohol/drug overdose
seizures w/gingical disease
esophageal motility disorders

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15
Q

common CAP viruses

A

influenza
RSV
adenovirus
parainfluenza

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16
Q

other CAP viruses

A

human metapnumonvirus
HSV
varicella-zoster
SARS associated coronavirus

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17
Q

2-3% incidence

A 
M. tuberculossis
chlamydophilia psittaci
coxiella burnetti
F. tularensis
B. pertusis
endemic fungi
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18
Q

drug resistant S. penumoniae (DRSP)

A 
65
B-lactam use w/in previous 3 yrs
alcoholics
immunosupressed
exposure to child at day care
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19
Q

outpatient in previous healthy

A

macrolide- azithromycin
doxycycline
both PO

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20
Q

outpatient at risk for DRSP

A

respiratory fluoroquinolone- levofloxacin
B-lactam- amoxicllin +macrolide
all PO

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21
Q

inpatient non ICU

A

respiratory fluoroquinolone- levofloxacin (PO or IV)

B-lactam- ceftriaxone + macrolide IV

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22
Q

ICU

A

respiratory fluoroquinolone- levofloxacin

B-lactam- ceftriaxone + macrolide IV

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23
Q

pseudomonas risks

A

structural lung disease
repeated COPD exacerbations with frequent corticosteroid and/or antibiotic use
prior antibiotic therapy

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24
Q

Tx for psudomonas

A

anti-psuudomonal B-lactam IV (piperacillin-taxobactam, cefepime) + either cipro or levofloxacin
or
beta lactam + gentamicin and azithromycin
or beta lactam + gentamycin +anti-psudomondal fluoroquinolone

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25
Q

CA-MRSA risk

A

end stage renal disease
injection drug abuse
prior influenza
prior antibiotic use

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26
Q

CA-MRSA Tx

A

add vancomycin or linezolid IV

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27
Q

panton-valentine leucocidin necrotizing pneumonia

A

add clindamycin or use linezolid

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28
Q

IV -> PO

A 
hemodynamically stable
normal temp and HR
RR 90
SAO2 >90%
normal mental status
tolerating oral meds
normal fnx of GI
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29
Q

duration of therapy

A

min 5 days, usually 7-10
must be afrebile for 48-72hours
no more then 1 CAP associated sign of clinical insatbility

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30
Q

duration of psudomonas therapy

A

15 days to prevent relapse

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31
Q

HAP

A

occurs 48hrs or more after admission
2nd most nosocomial infection in US
increases hospitalization 7-9days

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32
Q

VAP

A

arises in 48-72 hours after endotracheal intubation

occurs in 9-27%

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33
Q

HCAP

A

associated w/Hx of hospitalization or exposure to healthcare setting

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34
Q

HAP, VAP, HCAP onset

A

early onset <4days

late onset 5+ days

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35
Q

HAP, VAP, HCAP aerobic gram neg

A

P. aeruginosa
E. coli
K. pneumoniae
Acinetobacter

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36
Q

HAP, VAP, HCAP gram pos cocci

A

MRSA

more common in DM, head trauma, and ICU

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37
Q

HAP, VAP, HCAP oralpharyngeal pathogens

A

viridans group strep
coagulatse neg staph
neisseria
corynebacterium

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38
Q

Multi-drug resistant pathogens (MDR)

A 
psudomonas aeruginosa
klebsiella
enterobacter
serratia
MRSA
DRSP
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39
Q

psudomonas aeruginosa

A 
resistance caused by multiple efflux pumps
decreased expression of outer membrane porin Ch
increasing resistance to piperacllin
ceftazidime
cefepime
imipenem
meropenem
aminoglycosides
fluroquinolones
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40
Q

klebsiella

A

intrinsically resistant to ampicillin and can acquire resistance to cephalosporins and aztreonma -> ESBL production

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41
Q

enterobacter

A

high frequency of developing resistance to cephalosporins during Tx

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42
Q

klebsiella, enterobacter, serratis

A

carry plasmid mediated AmpC-type enzymes (ESBL) which are carbapenem susceptible, but concerned about reisitance

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43
Q

MRSA

A

> 50% of ICU infection
PBPs w/reduced affinity for B-lactams
concern for linezolid resistance, but still rare

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44
Q

DRSP

A

altered PBP

all MDR strains in US currently susceptible to vancomycin and linezolid

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45
Q

empiric therapy early onset

A

ceftiaxone or FQ or ampicillin/sublactam or ertapenem

46
Q

empiric therapy early onset pathogens

A

S. pneumoniae
H. influenza
MSSA
sensitive gram neg E. coli, Klebsiella, enterobacter, proteus, serratia

47
Q

empiric therapy late onset pathogens

A

P. aeruginosa
Klebsiella
acinetobacter
MRSA

48
Q

empiric therapy late onset

A 
antipseudomonal cephalosporin or
antipsudomonal carbapenem or beta lactam/bata lactamase inhibitor
\+
antipseudomonal FQ or aminoglycoside
\+
linezolid or vancomycin
49
Q

VAP duration of therapy

A

7 days, unless P. aeruginosa -> 15

50
Q

non resistant S. pneumoniae

A

Penicillin G

amoxicillin

51
Q

resistant S. pneumoniae

A 
cefotaxime
ceftriaxone
levofloxacin
moxifloxacin
vancomycin
linezolid
52
Q

H. influenza

A

non-B-lactamaase producing: amoxicillin

B-lactamase producing: 2nd or 3rd generation cephalosproin and amoxicillin

53
Q

M. pneumoniae

A

macrolide

tetracycline

54
Q

C. pneumoniae

A

macrolide

tetrocycline

55
Q

C. Psittaci

A

doxycylcine

56
Q

legionella

A

fluoroquinolone
azithromycin
doxycycline

57
Q

enterobacteriaecease

A

3rd or 4th genreation cephalosproin

carbapenem

58
Q

Psudomonas

A

antipseudomonal B-lactam + ciprofloxacin, levofloxacin, or an aminoglycoside

59
Q

S. aureus methicillin-sensative

A

antistaphylococcal penicillins
nafcillin
oxacillin
dicloxacillin

60
Q

MRSA

A

vancomycin or linezoid

61
Q

pneumocystis jiroveci

A

trimethoprim/sulfamethoxazole

62
Q

Bordetella pertussis

A

azithromycin

clarithromycin

63
Q

influenza virus

A

osteltamivir

zanamivir

64
Q

coccioidioides

A

no treatment necessary if otherwise healthy

if needed itraconazole, fluconazole

65
Q

histoplasmosis and blastomycosis

A

itraconazole

66
Q

B-lactams MOA

A

stuctural analongs of D-Ala-D-lAla
covelently bind benicillin-binding proteins (PBPs)
inhibit cell wall synthesis

67
Q

resistance B-lactams

A

structural difference in PBPs
decreased PBP affinity for B-lactam
inability for drug to reach site of action
active efflux pumps
drug destruction and inactivation by B-lactamases

68
Q

pencillins adverse effects

A 
allergic rxn
anaphylaxis
interstitial nephritis (rare)
GI
pseudomembranous colitis
69
Q

cephalosporins adverse rxn

A

1% risk of cross-rxn to penicillins
diarrhea
intolerance to alcohol

70
Q

carbapenems adverse effects

A

nausea/vomiting
seizures
hypersensitivity

71
Q

vancomycin MOA

A

inhibits cell wall synthesis

72
Q

vancomycin resistance

A

alteration of D-Ala-D-Ala target

which bind glycopeptides poorly

73
Q

vancomycin adverse effects

A 
macular skill rash
chills
fever
rash
red man syndrome (histamine)
hypotnesion
tachycardic
ototoxicity and nephrotoxicity
74
Q

fluoroquinolones MOA

A

concentration dependent
targets bacterial DNA gyrase and topoisomerase IV
active transport out of cell

75
Q

fluoroquinolones adverse effects

A

GI
CNS
rash, photosensitivity
achilles tendon rupture

76
Q

fluoroquinolones contraindications

A

kids

77
Q

30s inhibitors

A

aminoglycosides

tertracycline

78
Q

aminoglycosides advere efects

A

ototoxicity
nephrotoxicity
neuromuscular blockade

79
Q

tetracycline adverse effects

A

GI
superinfections w/C. difficile
photosensitivity
teeth discoloration

80
Q

50s inhbitiors

A

macrolides
clindamycin
streptogamins
linezolid

81
Q

macrolides adverse effects

A

GI
hepatoxicity
arrythmias

82
Q

clindamycin adverse effects

A

Diarrhea
C. dif
skin rash

83
Q

streptogramins adverse rxns

A

infusion pain and phelbitis

84
Q

linezolid adverse rxns

A

myelosupression
HA
rash

85
Q

neurominidase inhibitors

A

oseltamivir

anamivir

86
Q

neurominidase inhibitors MOA

A

analogs of sialic acid

interfere w/release of progeny influenza virus from infected host cell

87
Q

oseltamivir adverse effects

A

nausea, vomiting, abdominal pain
HA, fever, diarrhea, neuropsychiatric effects
children >1yr

88
Q

zanamirvir adverse effects

A 
cough
bronchospasm
decrease in pulmonary fnx
nasal/throat discomfort
not recommended in underlying airway disease
children >7
89
Q

neurominidase resistance

A

point mutation in viral hemagglutinin (HA) or neuroaminidase (NA)
all influenza A and B susceptible
H1N1 resistant ot oseltamivir

90
Q

uses of neuroamindase

A

influenza prophylaxis

influenza Tx

91
Q

M2Ch Blockers

A

amantadine

rimantadine

92
Q

M2Ch blocker MOA

A

block M2 proton ion Ch of virus inhibiting uncoating of viral RNA w/in host cell
only works against influenza A

93
Q

M2Ch blocker adverse effects

A 
GI
CNS
severe behavioral changes
delirium
agitation
seizures
94
Q

other anti-virals

A

acyclovir
valacylovir
ganciclovir
valgancyclovir

95
Q

acyclovir and valacylovir MOA

A

inhibits DNA synthesis

96
Q

acyclovir and valacylovir uses

A 
genital herepes
varicella
HSV
encephalitis
neonatal HSV
97
Q

acyclovir and valacylovi adverse effects

A

nausea
diarrhea
HA

98
Q

ganciclovir and valgancyclovir MOA

A

termination of DNA elongation

99
Q

ganciclovir and valgancyclovir uses

A

CMV retinitis

CMV prophylaxis

100
Q

ganciclovir and valgancyclovir adverse effects

A 
myelosuppression
nausea
diarrhea
fever
peripheral neuropathy
101
Q

antifungal uses

A 
candida albicans
histoplama
cryptococcus neoformans
coccidioides
adpergillus
blastomyces
102
Q

Azole antifungals MOA

A

inhibits fungal cytochrome P450 reducing production of ergosterol

103
Q

Azole antifungals uses

A 
candida
blastomycosis
coccidiodomycosis
histoplasmosis
aspergillus
104
Q

Azole antifungals adverse effects

A

minor GI
abnormal liver enzymes
drug interactions

105
Q

amphotericin B

A

polyene macrolide antibiotic

106
Q

amphotericin B MOA

A

binds ergosterol and changes permeabilty of cell by forming pores in cell membrane

107
Q

amphotericin B uses

A

broadest spectrum of activity

useful in life threatening situations, but very toxic

108
Q

amphotericin B uses

A 
infusion related
fever 
chills
HA
vomiting
cumulative toxicity ->renal damage
109
Q

echinocandins

A

caspofungin
micafungin
anidulafungin
all IV

110
Q

echinocandins MOA

A

inhibits synthesis of B-glucan

disrupts fungal cell wall -> cell death

111
Q

echinocandins uses

A

candida

aspergillus

112
Q

echinocandins adverse effects

A

minor GI

flushing

Resp II (15 decks)

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