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CRRAB II- FINAL > Lady Prunuske-Respiratory Pharm > Flashcards

Lady Prunuske-Respiratory Pharm Flashcards

1
Q

What is detected in a rapid strep test?

A

Carbohydrate capsule

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2
Q

MOA of Beta-Lactams?

Bactericidal or bacteriostatic?

A

Bind penicillin binding protein (transpeptidase) that is required for cell wall synthesis

Bactericidal

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3
Q

Aztreonam

A

Monobactam that is safe to use in patients with penicillin allergies.

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4
Q

Why wouldn’t aztreonam be effective against strep pharyngitis?

A

ONLY EFFECTIVE AGAINST GRAM - BUGS!

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5
Q

Describe the MOA of macrolides.

Which drugs are macrolides?

A

Inhibits translocation by binding to 23sRNA 50s ribosomal RNA near peptidyltransferase-blocking peptide chain elongation

  • Azithromycin
  • Clarithromycin
  • Erythromycin
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6
Q

Resistance to macrolides?

A

Methylation of 23sRNA

Increased efflux

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7
Q

Coverage for macrolides?

A

Broad coverage of respiratory pathogens

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8
Q

What class of drugs is used to treat both Influenza A and B and is most active 48 hours post-infection?

A

Neuraminidase inhibitors

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9
Q

What neuraminidase inhibitor can be used in kids >1 year?

MOA?

A

Oseltamivir

Oral prodrug activated by hepatic esterases (It is modified Tamiflu for renal insufficiency)

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10
Q

What neruaminidase inhibitor is used in kids 7 or older?

When is it useful?

A

Zanamivir

Useful in malabsorption or GI problems because it is inhaled (Don’t use in COPD, asthma)

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11
Q

What drug is used in patients 18 and over with influenza and is one dose IV?

A

Peramivir

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12
Q

What is the difference between antigenic shift and drift?

A

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

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13
Q

Prophylactic

A

No sx but at high risk of infection

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14
Q

Pre-emptive

A

active screening for bug, no sx, find that it is present and give drug

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15
Q

Empiric

A

Sx but no etiology

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16
Q

Definitive

A

Known organism, tailor therapy toward it

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17
Q

What is the empiric therapy for previously healthy outpatients with community-acquired pneumonia?

A

Macrolide or Doxycycline

18
Q

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?

A

Respiratory fluoroquinolone or beta-lactam

19
Q

What are the respiratory fluoroquinolones?
What is their MOA?
Cidal or static?

A

Gemifloxacin, levofloxican, moxifloxacin

Inhibit DNA replication by binding bacterial DNA Topo II and IV

Bactericidal

20
Q

What is the spectrum of fluoroquinolones?

What is the resistance to them?

A

Gram + and Gram - and atypical organisms like mycoplasma

Resistance: efflux, Topo mutations

21
Q

Can you give fluoroquinolones to kids or preganant women?

A

NO!

“Fluoroquinolones ruin the attachments to your bones” –aka tendinopathies

22
Q

What 2 drugs can be used to tx mycoplasma pneumonia?

A

Doxycycline

Azithromycin

23
Q

What class of drug does Doxycycline belong to?

MOA?

CIdal or static?

Resistance?

A

Tetracyclines

Binds 30s preventing attachment of aminoacyl-tRNA

Bacteriostatic

INCREASED EFFLUX

24
Q

Adverse effects of Doxy?

Can you give it to kids or pregnant women?

A

Photosensitivity
discoloration of teeth
Inhibits bone growth

NO!

25
Q

What is concentration-dependent killing?
Peak concentration is over how many times the MIC?

What drugs use this?

A

Achieve more killing at higher concentration

Peak concentration >10 x the MIC

Aminoglycosides, Fluoroquinolones

26
Q

What is time-dependent killing?

What drugs?

A

May need to dose multiple times per day, Time is more important than the MIC

Beta-lactams, Vancomycin

27
Q

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?

A

Klebsiella Pneumoniae Carbapenemase (KPC)

Extended spectrum Beta-lactamase (ESBL)

Colistin-Polymixin E binds to phosphatidylethanolamine in Gram - membrane to create holes!

28
Q

What 2 major drugs can be used to tx Methicillin Resistant Staph Aureus pneumonia?

A

Vancomycin and Linezolid

29
Q

MOA Vanco?

A

Binds to D-Ala-D-Ala dipeptide to inhibit transclycosylation to prevent cell wall synthesis

30
Q

MOA Linezolid?

A

Targets the 50 s ribosome and inhibits initiation of protein synthesis (Gram + organisms)

31
Q

Why should you avoid Daptomycin for tx of pneumonia?

A

It is inactivated by pulmonary surfactant

32
Q

What bug commonly infects people with CF?

A

Pseudomonas aeruginosa

33
Q

MOA Amphotericin B?

What is it active against?

A

Binds ergosterol, creates holes in membranes and electrolytes leak out

Yeast and molds

34
Q

Why is Amphotericin B toxic?

A

B/c it can bind to Cholesterol

35
Q

How do -azoles work?

A

Bind to fungal P-450 enzyme Erg11 to block production of ergosterol and causing accumulation of toxic sterol

36
Q

What drug do you use to treat systemic Aspergillus fumigatus?

A

Voriconazole

37
Q

What do antitussives do?

Name 2

A

Block cough reflex

Dextromethorphan, codein

38
Q

What does Guaifenisin do?

A

Thins mucus (an expectorant)

39
Q

If you combine what 2 classes of drugs may it make mucus thicker and harder to clear?

A

Decongestant and antihistamine

40
Q

If there is fungal CNS involvement, what do you treat with?

Follow it up with?

A

Amphotericin B followed up with Itraconazole

CRRAB II- FINAL (20 decks)

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