J kinder antibiotics/pneumonia

Question 1

Out patient infectious organisms (5)

Answer 1

Strept Pneumoniae
Haemophilus Influenzae
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Resp Viruses

Question 2

Hospitalized Pt infectious organisms (7)

Answer 2

Strept Pneumoniae
Mycoplasma pneumoniae
Chlamydophila pneumoniae
Haemophilus influenzae
Legionella spp
Aspiration
Resp Viruses

Question 3

ICU Pt infectious organisms

Answer 3

Strept Pneumoniae
Staph aureas
Legionella
Gram Neg
Haemophilus Influenzae

Question 4

Empiric - Healthy outpatient

Answer 4

Macrolide (azithromycin, Clarithromycin)
or
Doxycycline

Question 5

Empiric - DRSP risk outpatient (2)

Answer 5

Resp Fluroquinolone (Levofloxacin, Moxifloxacin, Gemifloxacin)
or
B-Lactam + Macrolide
{Blactam (Amoxicillin, Amoxicillin-clavulanate)
(Clavulanate is B lactmase inhibitor)
{Macrolide (azithromycin, Clarithromycin)

Question 6

Risk factors for DRSP (5)

Answer 6

B lactam use w/in last 3 months
65
Alcoholism
Immunosupression
Exposure to child at daycare

Question 7

Empiric Inpt (2)

Answer 7

Resp Fluroquinalone (Levofloxacin, moxifloxacin)
or
B lactam + Macrolide
B Lactam(Ceftriaxone, cefotaxime, or ampicillin)
Macrolide (azithromycin)

Question 8

Empiric ICU

Answer 8

B Lactam + azithromycin or Resp Fluorquinalone
B Lactam (Ceftriaxone, Cafotaxime, Ampicillin-sulbactam)
FQ (Levofloxacin, Moxifloxacin)

Question 9

Common Viruses (4) and less common (4)

Answer 9

Common:
Influenza
RSV
Adenovirus
Parainfluenza

Uncommon:
Human Metapnumovirus
HSV
Varicella-Zoster
SARS - associated corona virus

Question 10

Risk factor for Pseudomonas aeruginosa (3)

Answer 10

Structural lung disease (bronchiectasis)
Repeated COPD exacerbations (corticosteroid/Abx use)
Hx of ABx use

Question 11

Treatment if pseudomonas in expected

Answer 11

Anti-pseudomonas B-Lactam + Ciprofloxacin/levofloxacin

OR

B lactam + Aminoglycoside (gentamycin) + azithromycin

OR

Blactam + Aminoglycoside (gentamycin) + anti-pseudomonal FQ (Levo/Cipro)

Antipseudomonas Blactam (Piperacillin-Tazobactam, Cefepime, Imipenem, Meropenem)

Question 12

HAP/VAP/HCAP common infecting organisms
Gram Neg (4)
Gram Pos (1)
Oropharyngeal (4)

Answer 12

Gram Neg:
Pseudomonas aeruginosa
E. coli
Klebsiella Pneumoniae
Acinetobacter spp

Gram +
MRSA (DM, Head trauma, ICU)

Oropharyngeal:
Strept Viridans
Coag neg staph (epidermidis, saprophyticus)
Neiserria
Corynbacterium

Question 13

Pseudomonas aeruginosa MOdrug resistance

Answer 13

Drug efflux pumps
Fewer porin channels (doesn’t let drug in
Chromosomal induction of B-lactamase

Question 14

MRSA resistance mechanism

Answer 14

Reduced binding affinity of PBP for B lactams

PBP - penicillin binding protein

Question 15

HAP/VAP/HCAP no indictaion of MDR treatment

Answer 15

Ceftriaxone
Or
Fluroquinalone (levo/Moxi/Cipro)
Or
Ampicillin-sulbactam
Or
Ertapenem

Question 16

HAP/VAP/HCAP w/ MDR TMNT

Answer 16

ANtipseudomonal Cephalosporin (Ceftazidime, Cefepime)
OR
Antipseduo Carbapenem (Imipenum, meropenem)
OR
B-Lactam/Lactamase inhibitor (Piperacillin-tazobactam)

PLUS

Antipseudo FQ (Levo/Cipro)
OR
Aminoglycoside (amikacin, gentamicin, Tobramycin)

PLUS

Linezolid
OR
Vancomycin

Question 17

Neurominidase inhibitor
Drugs (2)
MOA
AE (7)
USE

Answer 17

Oseltamivir, Zanamivir (only focus on oseltamivir

Sialic Acid Analog - prevents release of influenza virus from infected cell

N/V/D ab pain, HA, fever, Neuropsychiatric

Influenza prophylaxis

Question 18

Azoles
Drugs (3)
MOA
AE (2)
Use

Answer 18

Fluconazole, Itraconazole, Voriconazole

Inhibit fungal P450 (reduces ergosterol)

Minor Gi upset, Abnormalities in liver enzymes

Candida, blastomycosis, coccidiodomoycosis, histoplasmosis, aspergillus