Lady Prunuske-Respiratory Pharm Flashcards
What is detected in a rapid strep test?
Carbohydrate capsule
MOA of Beta-Lactams?
Bactericidal or bacteriostatic?
Bind penicillin binding protein (transpeptidase) that is required for cell wall synthesis
Bactericidal
Aztreonam
Monobactam that is safe to use in patients with penicillin allergies.
Why wouldn’t aztreonam be effective against strep pharyngitis?
ONLY EFFECTIVE AGAINST GRAM - BUGS!
Describe the MOA of macrolides.
Which drugs are macrolides?
Inhibits translocation by binding to 23sRNA 50s ribosomal RNA near peptidyltransferase-blocking peptide chain elongation
- Azithromycin
- Clarithromycin
- Erythromycin
Resistance to macrolides?
Methylation of 23sRNA
Increased efflux
Coverage for macrolides?
Broad coverage of respiratory pathogens
What class of drugs is used to treat both Influenza A and B and is most active 48 hours post-infection?
Neuraminidase inhibitors
What neuraminidase inhibitor can be used in kids >1 year?
MOA?
Oseltamivir
Oral prodrug activated by hepatic esterases (It is modified Tamiflu for renal insufficiency)
What neruaminidase inhibitor is used in kids 7 or older?
When is it useful?
Zanamivir
Useful in malabsorption or GI problems because it is inhaled (Don’t use in COPD, asthma)
What drug is used in patients 18 and over with influenza and is one dose IV?
Peramivir
What is the difference between antigenic shift and drift?
Drift: small gene mutation leading to altered antibody-binding sites…still some cross-immunity with previous strains
Shift: basically a whole new subtype via RNA rearrangement leading to altered surface proteins and antigenic profile)
Drift is when the car in front of you swiftly moves between lanes but shift is when the car in front of you turns around and starts driving the wrong direction
Prophylactic
No sx but at high risk of infection
Pre-emptive
active screening for bug, no sx, find that it is present and give drug
Empiric
Sx but no etiology
Definitive
Known organism, tailor therapy toward it
What is the empiric therapy for previously healthy outpatients with community-acquired pneumonia?
Macrolide or Doxycycline
What is the empiric therapy for outpatients with comorbidities who have community-acquired pneumonia or people who have been on antibiotics in the past 3 months?
Respiratory fluoroquinolone or beta-lactam
What are the respiratory fluoroquinolones?
What is their MOA?
Cidal or static?
Gemifloxacin, levofloxican, moxifloxacin
Inhibit DNA replication by binding bacterial DNA Topo II and IV
Bactericidal
What is the spectrum of fluoroquinolones?
What is the resistance to them?
Gram + and Gram - and atypical organisms like mycoplasma
Resistance: efflux, Topo mutations
Can you give fluoroquinolones to kids or preganant women?
NO!
“Fluoroquinolones ruin the attachments to your bones” –aka tendinopathies
What 2 drugs can be used to tx mycoplasma pneumonia?
Doxycycline
Azithromycin
What class of drug does Doxycycline belong to?
MOA?
CIdal or static?
Resistance?
Tetracyclines
Binds 30s preventing attachment of aminoacyl-tRNA
Bacteriostatic
INCREASED EFFLUX
Adverse effects of Doxy?
Can you give it to kids or pregnant women?
Photosensitivity
discoloration of teeth
Inhibits bone growth
NO!
What is concentration-dependent killing?
Peak concentration is over how many times the MIC?
What drugs use this?
Achieve more killing at higher concentration
Peak concentration >10 x the MIC
Aminoglycosides, Fluoroquinolones
What is time-dependent killing?
What drugs?
May need to dose multiple times per day, Time is more important than the MIC
Beta-lactams, Vancomycin
What bug is spread on health care providers hands?
What does it express that makes it hard to tx?
What to you treat it with? How does it work?
Klebsiella Pneumoniae Carbapenemase (KPC)
Extended spectrum Beta-lactamase (ESBL)
Colistin-Polymixin E binds to phosphatidylethanolamine in Gram - membrane to create holes!
What 2 major drugs can be used to tx Methicillin Resistant Staph Aureus pneumonia?
Vancomycin and Linezolid
MOA Vanco?
Binds to D-Ala-D-Ala dipeptide to inhibit transclycosylation to prevent cell wall synthesis
MOA Linezolid?
Targets the 50 s ribosome and inhibits initiation of protein synthesis (Gram + organisms)
Why should you avoid Daptomycin for tx of pneumonia?
It is inactivated by pulmonary surfactant
What bug commonly infects people with CF?
Pseudomonas aeruginosa
MOA Amphotericin B?
What is it active against?
Binds ergosterol, creates holes in membranes and electrolytes leak out
Yeast and molds
Why is Amphotericin B toxic?
B/c it can bind to Cholesterol
How do -azoles work?
Bind to fungal P-450 enzyme Erg11 to block production of ergosterol and causing accumulation of toxic sterol
What drug do you use to treat systemic Aspergillus fumigatus?
Voriconazole
What do antitussives do?
Name 2
Block cough reflex
Dextromethorphan, codein
What does Guaifenisin do?
Thins mucus (an expectorant)
If you combine what 2 classes of drugs may it make mucus thicker and harder to clear?
Decongestant and antihistamine
If there is fungal CNS involvement, what do you treat with?
Follow it up with?
Amphotericin B followed up with Itraconazole
