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PHARM: Bacterial Infections Flashcards

1
Q

What is the most important factor in successful treatment of pneumonia?

A

EARLY INTERVENTION (do not wait on blood/sputum cultures to start drug therapy)

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2
Q

What are the most common causes of nocosomial pneumonia?

A

Staph aureus

Pseudomonias aeruginosa

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3
Q

Klebsiella pneumoniae most frequently causes pneumonia in what patients?

A

Diabetics

Alcoholics

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4
Q

What are the top causes of pneumonia in new-borns?

A

Group B streptococci

E. coli

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5
Q

What are the top causes of pneumonia in children 6 weeks - 18 years old?

A

Viruses
Mycoplasma pneumoniae
Chlamydia pneumoniae
Streptococcus pneumoniae

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6
Q

What are the top causes of pneumonia in adults 18-40 y/o?

A

mycoplasma pneumoniae

streptococcus pneumoniae

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7
Q

What are the top causes of pneumonia in adults 40-65 y/o?

A

Streptococcus pneumonoiae
Haemophilus influenza
Anaerobes

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8
Q

Why is chronic alcohol use an independent risk factor for severe CAP?

A

chronic drinkers have decreased saliva production (which is an important mucosal defense)

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9
Q

Why is diabetes an independent risk factor for severe CAP?

A

the disorder neutralizes the effects of protective proteins on the surface of the lungs

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10
Q

What is the only antimicrobial actually labeled for use in Legionnaire’s disease?

A

erythromycin

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11
Q

What do physicians commonly use to treat Legionnaire’s disease?

A

azithromycin (and a respiratory quinolone like levofloxacin)

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12
Q

What is standard treatment for outpatient CAP?

A

Macrolide (erythromycin) or Doxycycline

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13
Q

How does treatment for outpatient CAP change if the patient uses steroids or antibiotics in the prior 3 months? *this is same treatment as you use for NURSING HOME PATIENTS

A

Fluoroquinolone
Amoxicillin + Clavulanic acid
2nd generation macrolide (clarithromycin) + cephalosporin

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14
Q

How do you treat CAP in a hospital ward?

A

Fluoroquinolone
Amoxicillin + Clavulanic acid
2nd generation macrolide (clarithromycin)/3rd generation macrolide (azithromycin) + cephalosporin

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15
Q

How do you treat ICU CAP?

A

3rd generation cephalosporin + macrolide
Piperacillin + Tazobactam
Fluoroquinolone

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16
Q

List commonly used macrolides.

A

Erythromycin (1st gen)
Clarithromycin (2nd gen)
Azithromycin (3rd gen)

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17
Q

What is the MOA of macrolides?

A

Bind to 23s subunit of 50s to inhibit translocation (peptidyl transferase)

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18
Q

What are resistance mechanisms against macrolides?

A

Ribosomal methylation and mutation of 23S rRNA

Active efflux

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19
Q

What is the major toxicity of erythromyxin?

A

CYP3A4 inhibitor
Cholestatic Jaundice
QT prolongation

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20
Q

What is the major toxicity of azithromycin?

A

Cholestatic jaundice

QT prolongation

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21
Q

List examples of tetracyclines.

A

Doxycycline

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22
Q

What is the MOA of tetracyclines

A

Bind to 16s subunit of 30s and weaken ribosome-tRNA interaction to prevent protein synthesis

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23
Q

What are resistance mechanisms against tetracyclines?

A

Decreased entry into bacteria
Increased efflux from bacteria
Target insensitivity

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24
Q

What is the major toxicities of doxycycline?

A

teeth discoloration
photosensitivity
decreased bone growth

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25
Name an example of a fluoroquinolone.
Levofloxacin
26
What is the MOA of fluoroquinolones?
Gram Neg- inhibit DNA gyrase Gram positive- inhibit topoisomerase IV *prevent DNA replication
27
What are resistance mechanisms against fluoroquinolones?
mutation of DNA gyrase | active efflux
28
What is the major toxicity associated with levofloxacin?
``` tendon rupture (adults) cartilage damage (children) ```
29
List examples of penicillins.
Amoxicillin + Clavulanic acid | Piperacillin + Tazobactam
30
Why are penicillins given with clavulanic acid or tazobactam?
those are beta-lactamase inhibitors
31
Which beta lactams work on gram negative bacteria (can cross through the LPS-coated outer membrane)?
Penicillin G Aminopenicillins Later-generation cephalosporins (cefepime, ceftazidime)
32
What beta lactams are resistant to beta-lactamase?
Narrow spectrum penicillins (Meth, naf, ox) | Carbapenem
33
What is the MOA of penicillin.
Similar to D-Ala-D-Ala structure, so bind to PBP (transpeptidases) on bacteria and block cross-linking of peptidoglycan cell wall to destroy it
34
What are methods of resistance to penicillins?
``` Drug inactivation by beta-lactamase Altered PBPs (target insensitivity) ```
35
What is the major toxicities of aminopenicillins (amoxicillin and ampicillin)?
Cross reactivity with penicillin | aculopapular rash
36
What is the major toxicity of broad range penicillin (piperacillin)?
partial cross reactivity with ceph hypersensitivity | Decreased coagulation
37
List an example of a carbapenem.
Meropenem
38
What is the MOA of carbapenem.
similar to penicillin (because it is also a beta-lactam)
39
What is the major toxicity of meropenem?
partial cross-reactivity with penicillin/ceph hypersensitivity Seizures
40
List some cephalosporins.
``` 1st gen- Cefazolin 2nd gen- Cefuroxime 3rd gen- Ceftriazone 4th gen- Ceftazidime, Cefepime (have anti-pseudomonal activity) ```
41
What is the MOA of cephalosporins?
Inhibition of cell wall cross-linking
42
What are mechanisms of resistance to cephalosporins?
Decreased permeability of gram negative outer membrane (altered porins) Active Efflux
43
What are the major toxicities of cephalosporins?
``` Cross-reactivity within class partial cross-reactivity with penicillin ```
44
List an example of an aminoglycoside
Gentamicin
45
What is the MOA of aminoglycosides?
Binds to 30s ribosomal subunit and pokes holes in membrane
46
What are the major mechanisms of resistance to aminoglycosides?
Drug inactivation Decreased permeability of gram negative outer membrane Active efflux Ribosomal methylation
47
What are the major toxicities of gentamicin?
nephro- and ototoxicity | Neuromuscular paralysis
48
What drugs are used to treat nosocomial pneumonia?
Impenem/Cilastin Azetronam Ceftazidime (all of these have activity against gram negative aerobes)
49
What drug is preserved to treat MRSA?
vancomycin (IV)
50
What drugs are used to treat aspiration pneumonia?
clindamycin or ampicillin/sulbactam
51
What class of drugs in clindamycin in?
lincosamides
52
What is the MOA of clindamycin?
binds to 23s of 50s and inhibits protein synthesis by blocking translocation
53
What are methods of resistance against clindamycin?
Methylation of binding site | enzymatic inactivation
54
What is the mechanism of action for vancomycin?
ONLY USEFUL IN DIVIDING Gram (+) bugs | Binds D-ala-D-ala terminus of peptide precursor and inhibits peptidoglycan polymerase and transpeptidation reaction
55
What are methods of resistance against vancomycin?
Replacement of D-ala by D-lactate
56
What are the major toxicities associated with vancomycin?
nephro- and ototoxicity | Red Man's syndrome
57
What class of antibiotics has high oral bioavailability, making it easy to swap from parenteral to oral dosage?
fluoroquinolones
58
Which classes of antibiotics are concentration dependent? (increased conc. of drug kills bacteria at higher rate)
fluoroquinolones aminoglycosides (give in large doses at long intervals)
59
Which class of antibiotics is time dependent? (bacterial density is proportional to time that concentrations exceed the MIC)
beta-lactams (penicillins, cephalosporins, carbapenems) Dose frequently to achieve drug level about MIC for 30-50% of the dose interval
60
Which antibiotics do NOT need to be dose adjusted for renal impairment (they are more biliary eliminated)?
``` Azithomycin Ceftriazone Clindamycin Doxycycline Erythromycin Linezolid ```
61
What antibiotic has postential for interaction with concurrent non-antimicrobial agents?
linezolid (with non-specific MAOIs)
62
What antibiotic is absolutely contraindicated in breastfeeding?
metronidazole
63
Why is daptomycin NOT used for pulmonary infections?
it distributes into lung tissue but it is INHIBITED BY SURFACTANT!
64
What is the most common cause of bronchitis in smokers?
H. influenzae
65
What treatment is indicated for bronchitis?
Amoxicillin + Clavulanic acid Azithromycin Clarithromycin Doxycycline
66
What bacteria typically are found in lung abscesses?
Anaerobes - Community acquired: gram pos. cocci - Nosocomial: gram neg. bacilli
67
What is appropriate treatment for community acquired pulmonary abscess?
clindamycin
68
What is appropriate treatment for nocosomial pulmonary abscess?
methronidazole + ceftriaxone

Pulmonary (34 decks)

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