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Year 2 Resp Exam 2 > Drugs for Tx of Respiratory Infections, J Kinder, DSA > Flashcards

Drugs for Tx of Respiratory Infections, J Kinder, DSA Flashcards

1
Q

what are the common outpatient respiratory microbes causing CAP

A 
S pneumoniae
Mycoplasma pneumoniae
Haemophilus influenzae
Chlamydophila pneumoniae
Respiratory viruses
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2
Q

What are the common hospitalized respiratory microbes causing CAP

A 
S pneumoniae
M pneumoniae
C pnuemoniae
H influenzae
Legionella spp
Aspiration
Respiratory viruss
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3
Q

What are the common intensive care unit respiratory microbes causing CAP

A 
S penumoniae
S aureus
Legionella
Gram - bacilli
H influenzae
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4
Q

with use of chronic oral steroids what microbes are more common with CAP

A

enterobacteriaceae

Pseudomonas

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5
Q

what are common viruses causing CAP

A

influenza, RSV, adeno, parainfluenza

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6
Q

What are risk factors for drug resistant streptococcus penumoniae

A 
B lactam withing previous 3 mo!!
age 65 yrs
alcoholism
immunosuppressive illness or therapy
exposure to child at day care
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7
Q

what is empiric Tx CAP for outpatient prevoiusly healthy individual

A

Macrolide(zpak) or doxy

both PO

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8
Q

empiric Tx CAP for outpatient at risk for DRSP,

A

respiratory FQ PO(levo or moxi)
or
B lactam PO (amoxicillin) + macrolide PO

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9
Q

empiric Tx CAP for inpatient, non-ICU

A

Respiratory FQ PO
or
B lactam IV (ceftriazone, cefotaxime or ampicillin) + macrolide IV

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10
Q

empiric Tx CAP inpatient ICU

A

B lactam IV + azithromycin IV
or
B lactam IV + respiratory FQ

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11
Q

Risk factors for pseudomonas aeruginosa infection

A

structural lung disease
repeated COPD exacerbations
Prior antibiotic Tx

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12
Q

Tx for pseudomonas

A 
Anti-pseudomonal B lactam IV (piperacillin-tazobactam, cefepime, imipenem, meropenem)
\+ cipro or levo
or
B lactam + AG + zpak
or 
B lactam + AG + antipseudomonal FQ
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13
Q

What are risk factors for community-acquired methicillin-resistant Staph aureus

A

end stage renal disease
injection drug abuse
prior influenza
prior antibiotic use (especially FQ)

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14
Q

Tx community acquired MRSA

A

vanco IV or linezolid

Panton-Valentine leucocidin necrotizing pneumonia (add clinda or use linezolid)

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15
Q

How long do you Tx CAP

A

minimum 5 days (most 7-10)
afebrile 48-72 hours
exception: Pseudomonas- 8 day course led to more relapse compared to 15 day course

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16
Q

What are common infecting organisms for HAP

A

Aerobic gram - : pseudomonas, E coli, Klebseilla, acinetobacter spp
gram + cocci: MRSA
oropharyngeal: viridans, coagulase - staph, neisseria, corynebacterium

17
Q

What are the R mechanisms of pseudomonas

A

Multiple efflux pumps
decreased expression of outer membrane porin channel
chromosomal induction of B lactamases

18
Q

Pseudomonas is gaining R to what

A

piperacillin, ceftazidime, cefepime, imipenem, meropenem, aminoglycosides, FQs

19
Q

how is MRSA gaining resistance

A

reduced affinity of penicillin-binding proteins for B lactams

20
Q

early onset HAP pathogens

A

S pneumoniase
H influenzae
MSSA
sensitive gram - : E coli, klebsiella, enterobacter spp, proteus spp, serratia

21
Q

Tx for HAP early onset

A 
Ceftiazone
or
FQ
or
ampicillin/sulbactam
or
ertapenem
22
Q

what are the late onset HAP pathogens

A

Pseudomonas, klebsiella ESBL+, acinetobacter, MRSA

23
Q

Tx for late onset HAP

A 
antipseudomonal cephalosporin
or
antipseudomonal carbapenem
or
B lactam
\++++++
antipseudomonal FQ or AG
\++++++
Linezolid or vanco
24
Q

Duration therapy for HAP

A

ventilator acquired- 6 days
usually short around 7 days
pseudomonas needs minimum 8

25
Q

What are the neuroamidase inhibitors that we use for CAP

A

oseltamivir PO

26
Q

how does oseltamivir work

A

analog of sialic acid, interferes with release of progeny influenza virus from infected cell

27
Q

adverse effects oseltamivir

A

nausea, vomiting, abdominal pain, HA, fever, diarrhea, neuropsych
approved in children >1 yr

28
Q

therapeutic use oseltamivir

A

influenza prophylaxis, influenza Tx

29
Q

What are the M2 channel blockers

A

amantadine, rimantadine
only effective against influenza A
** not in red

30
Q

What are the antivirals for HSV and VZV

A

acyclovir and valavyclovir

31
Q

Adverse effects of acyclovir and valavyclovir

A

nasuea, diarrhea, HA

32
Q

therapeutic use of acyclovir

A

genital herpes, varicella, HSV encephalitis, neonatal HSV Tx

33
Q

What are the antivirals for CMV

A

ganciclovir and valganciclovir

34
Q

What are the antifungals used to Tx CAP

A

fluconazole PO IV
itraconazole PO
voriconazole PO IV

35
Q

MOA antifungals Tx of CAP

A

inhibit fungal cytochrome p450, reducing production ergosterol

36
Q

adverse effects antifungals

A

minor GI upset, abnormal liver enzymes

37
Q

what is therapeutic use of antifungals

A

wide spectrum of activity against Candida spp, blastomycosis, coccidiodomycosis, histoplasmosis and even aspergillus

Year 2 Resp Exam 2 (33 decks)

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