Drugs to Tx CAP, HAP, and VAP (Pneumonia)

Question 1

What do penicillins inhibit and how?

What does this cause?

Answer 1

1) Bacterial cell wall synthesis by binding to the penicillin binding proteins
2) PBP binding inhibits peptidoglycan synthesis

Question 2

What is the role of clavulanate when combined with amoxicillin and the role of tazobactam when combined with piperacillin?

Answer 2

Inhibit beta lactamase

Question 3

Which broad-spectrum penicillin/β-lactamase inhibitor combo is active against pseudomonas?

Answer 3

piperacillin and tazobactam

Question 4

What is the clinical application of amoxicillin and clavulanate?

For piperacillin and tazobactam?

Answer 4

1) Community-acquired pneumonia

2) Community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-acquired pneumonia

Question 5

Which broad-spectrum penicillin/β-lactamase inhibitor combo is given orally?

IV?

Answer 5

1) amoxicillin and clavulanate

2) piperacillin and tazobactam

Question 6

When should you adjust the dosage of ceftriaxone if the patient has renal impairment?

Answer 6

Never because ceftriaxone is not eliminated by the kidneys

Question 7

What are the parenteral cephalosporins?

Answer 7

1) Ceftriaxone

2) Cefepime

Question 8

What are the oral cephalosporins?

Answer 8

1) cefpodoxime

2) cefditoren

Question 9

What is the MOA of the cephalosporins?

Answer 9

1) Inhibit bacterial cell wall synthesis by binding to the penicillin binding proteins
2) PBP binding inhibits peptidoglycan synthesis

Question 10

What is the clinical application for cefpodoxime and cefditoren?

Answer 10

Community-acquired pneumonia for outpatient therapy

Question 11

Why can cefpodoxime and cefditoren be used in outpatient therapy?

Answer 11

They are administered orally

Question 12

What toxicity may arise with cefpodoxime and cefditoren?

Answer 12

Beta-lactam allergy

Question 13

What is the MOA of the tetracylines?

Answer 13

Kills bacteria lacking cell walls such as Mycoplasma pneumonia

Question 14

What is the tetracycline drug of choice for community acquired pneumonia?

Answer 14

Doxycycline

Question 15

Why do you not want to use tetracyclines in young kids?

Answer 15

Will stain their developing permanent teeth

Question 16

Why is it important to take tetracyclines with lots of water?

Answer 16

It can cause esophageal irritation and ulceration

Question 17

What are the macrolide drugs of choice for community acquired pneumonia?

Answer 17

1) azithromycin

2) clarithromycin

Question 18

The macrolides are most effective against what microorganisms?

Answer 18

Aerobic and anaerobic gram-positive microorganisms (beta-hemolytic streptococci, pneumococci, staphylococci, and enterococci)

Question 19

Which macrolide can cause epigastric pain and is a well known inhibitor of cytochrome P450 metabolism?

Which causes less GI pain but is also a cytochrome P450 inhibitor?

Which does not inhibit cytochrome P450 and concentrates in cells which slowly release bacteriostatic levels of drugs?

Answer 19

1) erythromycin
2) clarithromycin
3) azithromycin

Question 20

What are generally more effective than tetracyclines or macrolides for pneumonia, but should be reserved to minimize appearance of tolerance?

Answer 20

Fluoroquinolones such as levofloxacin, gemifloxacin and moxifloxacin

Question 21

What can the fluoroquinolones increase the risk for?

What population is most at risk for this occurring?

Answer 21

1) Tendon rupture such as the Achilles

2) Children and elderly

Question 22

What is given by IV for serious infections caused by susceptible organisms resistant to penicillins (MRSA and MRSE) or in individuals with serious allergy to penicillins?

Answer 22

Vancomycin

Question 23

What is the MOA of linezolid?

Answer 23

Binds to the ribosomal A site to prevent tRNA binding

Question 24

What is the clinical use of linezolid?

Answer 24

1) Treatment of CAP caused by Streptococcus pneumoniae

2) Treatment of HAP caused by S. aureus

Question 25

What is the difference between linezolid and vancomycin in terms of pharmacokinetics?

Answer 25

Linezolid is orally active

Question 26

What is the cause of most of the toxicities experienced by linezolid?

Answer 26

It inhibits monoamine oxidase

Question 27

Aztreonam is useful against a wide spectrum of gram-negative aerobic pathogens such as?

Answer 27

Pseudomonas aeruginosa

Question 28

imipenem is reserved for last resort therapy because?

Answer 28

It is active against many multi-resistant strains

Question 29

gentamicin which is an aminoglycoside works by binding to the bacterial 30s ribosomal subunit and has what classic black box warnings?

Answer 29

1) Nephrotoxicity

2) Ototoxicity