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Pulmonary > PHARM: Bacterial Infections > Flashcards

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
Q

Name an example of a fluoroquinolone.

A

Levofloxacin

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26
Q

What is the MOA of fluoroquinolones?

A

Gram Neg- inhibit DNA gyrase
Gram positive- inhibit topoisomerase IV

*prevent DNA replication

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27
Q

What are resistance mechanisms against fluoroquinolones?

A

mutation of DNA gyrase

active efflux

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28
Q

What is the major toxicity associated with levofloxacin?

A 
tendon rupture (adults)
cartilage damage (children)
29
Q

List examples of penicillins.

A

Amoxicillin + Clavulanic acid

Piperacillin + Tazobactam

30
Q

Why are penicillins given with clavulanic acid or tazobactam?

A

those are beta-lactamase inhibitors

31
Q

Which beta lactams work on gram negative bacteria (can cross through the LPS-coated outer membrane)?

A

Penicillin G
Aminopenicillins
Later-generation cephalosporins (cefepime, ceftazidime)

32
Q

What beta lactams are resistant to beta-lactamase?

A

Narrow spectrum penicillins (Meth, naf, ox)

Carbapenem

33
Q

What is the MOA of penicillin.

A

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
Q

What are methods of resistance to penicillins?

A 
Drug inactivation by beta-lactamase
Altered PBPs (target insensitivity)
35
Q

What is the major toxicities of aminopenicillins (amoxicillin and ampicillin)?

A

Cross reactivity with penicillin

aculopapular rash

36
Q

What is the major toxicity of broad range penicillin (piperacillin)?

A

partial cross reactivity with ceph hypersensitivity

Decreased coagulation

37
Q

List an example of a carbapenem.

A

Meropenem

38
Q

What is the MOA of carbapenem.

A

similar to penicillin (because it is also a beta-lactam)

39
Q

What is the major toxicity of meropenem?

A

partial cross-reactivity with penicillin/ceph hypersensitivity
Seizures

40
Q

List some cephalosporins.

A 
1st gen- Cefazolin
2nd gen- Cefuroxime
3rd gen- Ceftriazone
4th gen- Ceftazidime, Cefepime 
(have anti-pseudomonal activity)
41
Q

What is the MOA of cephalosporins?

A

Inhibition of cell wall cross-linking

42
Q

What are mechanisms of resistance to cephalosporins?

A

Decreased permeability of gram negative outer membrane (altered porins)
Active Efflux

43
Q

What are the major toxicities of cephalosporins?

A 
Cross-reactivity within class
partial cross-reactivity with penicillin
44
Q

List an example of an aminoglycoside

A

Gentamicin

45
Q

What is the MOA of aminoglycosides?

A

Binds to 30s ribosomal subunit and pokes holes in membrane

46
Q

What are the major mechanisms of resistance to aminoglycosides?

A

Drug inactivation
Decreased permeability of gram negative outer membrane
Active efflux
Ribosomal methylation

47
Q

What are the major toxicities of gentamicin?

A

nephro- and ototoxicity

Neuromuscular paralysis

48
Q

What drugs are used to treat nosocomial pneumonia?

A

Impenem/Cilastin
Azetronam
Ceftazidime
(all of these have activity against gram negative aerobes)

49
Q

What drug is preserved to treat MRSA?

A

vancomycin (IV)

50
Q

What drugs are used to treat aspiration pneumonia?

A

clindamycin
or
ampicillin/sulbactam

51
Q

What class of drugs in clindamycin in?

A

lincosamides

52
Q

What is the MOA of clindamycin?

A

binds to 23s of 50s and inhibits protein synthesis by blocking translocation

53
Q

What are methods of resistance against clindamycin?

A

Methylation of binding site

enzymatic inactivation

54
Q

What is the mechanism of action for vancomycin?

A

ONLY USEFUL IN DIVIDING Gram (+) bugs

Binds D-ala-D-ala terminus of peptide precursor and inhibits peptidoglycan polymerase and transpeptidation reaction

55
Q

What are methods of resistance against vancomycin?

A

Replacement of D-ala by D-lactate

56
Q

What are the major toxicities associated with vancomycin?

A

nephro- and ototoxicity

Red Man’s syndrome

57
Q

What class of antibiotics has high oral bioavailability, making it easy to swap from parenteral to oral dosage?

A

fluoroquinolones

58
Q

Which classes of antibiotics are concentration dependent? (increased conc. of drug kills bacteria at higher rate)

A

fluoroquinolones
aminoglycosides

(give in large doses at long intervals)

59
Q

Which class of antibiotics is time dependent? (bacterial density is proportional to time that concentrations exceed the MIC)

A

beta-lactams (penicillins, cephalosporins, carbapenems)

Dose frequently to achieve drug level about MIC for 30-50% of the dose interval

60
Q

Which antibiotics do NOT need to be dose adjusted for renal impairment (they are more biliary eliminated)?

A 
Azithomycin
Ceftriazone
Clindamycin
Doxycycline
Erythromycin
Linezolid
61
Q

What antibiotic has postential for interaction with concurrent non-antimicrobial agents?

A

linezolid (with non-specific MAOIs)

62
Q

What antibiotic is absolutely contraindicated in breastfeeding?

A

metronidazole

63
Q

Why is daptomycin NOT used for pulmonary infections?

A

it distributes into lung tissue but it is INHIBITED BY SURFACTANT!

64
Q

What is the most common cause of bronchitis in smokers?

A

H. influenzae

65
Q

What treatment is indicated for bronchitis?

A

Amoxicillin + Clavulanic acid
Azithromycin
Clarithromycin
Doxycycline

66
Q

What bacteria typically are found in lung abscesses?

A

Anaerobes

  • Community acquired: gram pos. cocci
  • Nosocomial: gram neg. bacilli
67
Q

What is appropriate treatment for community acquired pulmonary abscess?

A

clindamycin

68
Q

What is appropriate treatment for nocosomial pulmonary abscess?

A

methronidazole + ceftriaxone

Pulmonary (34 decks)

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