Drugs to Tx CAP, HAP, and VAP (Pneumonia) Flashcards
What do penicillins inhibit and how?
What does this cause?
1) Bacterial cell wall synthesis by binding to the penicillin binding proteins
2) PBP binding inhibits peptidoglycan synthesis
What is the role of clavulanate when combined with amoxicillin and the role of tazobactam when combined with piperacillin?
Inhibit beta lactamase
Which broad-spectrum penicillin/β-lactamase inhibitor combo is active against pseudomonas?
piperacillin and tazobactam
What is the clinical application of amoxicillin and clavulanate?
For piperacillin and tazobactam?
1) Community-acquired pneumonia
2) Community-acquired pneumonia, hospital-acquired pneumonia, and ventilator-acquired pneumonia
Which broad-spectrum penicillin/β-lactamase inhibitor combo is given orally?
IV?
1) amoxicillin and clavulanate
2) piperacillin and tazobactam
When should you adjust the dosage of ceftriaxone if the patient has renal impairment?
Never because ceftriaxone is not eliminated by the kidneys
What are the parenteral cephalosporins?
1) Ceftriaxone
2) Cefepime
What are the oral cephalosporins?
1) cefpodoxime
2) cefditoren
What is the MOA of the cephalosporins?
1) Inhibit bacterial cell wall synthesis by binding to the penicillin binding proteins
2) PBP binding inhibits peptidoglycan synthesis
What is the clinical application for cefpodoxime and cefditoren?
Community-acquired pneumonia for outpatient therapy
Why can cefpodoxime and cefditoren be used in outpatient therapy?
They are administered orally
What toxicity may arise with cefpodoxime and cefditoren?
Beta-lactam allergy
What is the MOA of the tetracylines?
Kills bacteria lacking cell walls such as Mycoplasma pneumonia
What is the tetracycline drug of choice for community acquired pneumonia?
Doxycycline
Why do you not want to use tetracyclines in young kids?
Will stain their developing permanent teeth
Why is it important to take tetracyclines with lots of water?
It can cause esophageal irritation and ulceration
What are the macrolide drugs of choice for community acquired pneumonia?
1) azithromycin
2) clarithromycin
The macrolides are most effective against what microorganisms?
Aerobic and anaerobic gram-positive microorganisms (beta-hemolytic streptococci, pneumococci, staphylococci, and enterococci)
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?
1) erythromycin
2) clarithromycin
3) azithromycin
What are generally more effective than tetracyclines or macrolides for pneumonia, but should be reserved to minimize appearance of tolerance?
Fluoroquinolones such as levofloxacin, gemifloxacin and moxifloxacin
What can the fluoroquinolones increase the risk for?
What population is most at risk for this occurring?
1) Tendon rupture such as the Achilles
2) Children and elderly
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?
Vancomycin
What is the MOA of linezolid?
Binds to the ribosomal A site to prevent tRNA binding
What is the clinical use of linezolid?
1) Treatment of CAP caused by Streptococcus pneumoniae
2) Treatment of HAP caused by S. aureus
What is the difference between linezolid and vancomycin in terms of pharmacokinetics?
Linezolid is orally active
What is the cause of most of the toxicities experienced by linezolid?
It inhibits monoamine oxidase
Aztreonam is useful against a wide spectrum of gram-negative aerobic pathogens such as?
Pseudomonas aeruginosa
imipenem is reserved for last resort therapy because?
It is active against many multi-resistant strains
gentamicin which is an aminoglycoside works by binding to the bacterial 30s ribosomal subunit and has what classic black box warnings?
1) Nephrotoxicity
2) Ototoxicity
