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2020 CPR II Pulm Exam 2 > PHARM Pneumonia (Wolff) > Flashcards

PHARM Pneumonia (Wolff) Flashcards

1
Q

The fluoroquinolone, Ciprofloxacin, inhibiys what enzyme?

A

DNA Gyrase

important in killing Gram - bacteria (pseudomonas)

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2
Q

Fluoroquinolones that block Topo IV is important for killing which type of organisms?

A

Gram +

(streptococcus respt. infections)

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3
Q

Are fluoroquinolones a first choice drug or a last resort drug for CAP?

A

Last resort for CAP

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4
Q

Should penicillins and aminoglycosides be combined in the same IV?

A

NO!

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5
Q

What is the MOA of Amoxicilin?

What step of peptidoglycan synthesis is inhibited?

Is it effective against G+ and G-?

A

inhibits bacterial cell wall synthesis by binding to PBP

the final transpeptidation step is inhibited

Yes

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6
Q

Does Amoxicillin +/- Clavulanate kill Pseuodomonas?

What is this combination used for?

A

No!

CAP

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7
Q

what are the main adverse effects of Amoxicillin +/- Clavulanate?

A

Anaphylactic Rxn

C. Diff

In Mono-rash

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8
Q

What is the MOA of Piperacillin?

What is the MOA of Tazobactam?

Is it active against Pseudomonas?

A

inhibits bacterial cell wall synthesis

Inhibits beta-lactamases

Yes!

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9
Q

Piperacillin + Tazobactam kill which types of pathogens?

A

Gram + and Gram - aerobic and anaerobic, including those who produce beta-lactamases

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10
Q

What are the main indications for Piperacillin + Tazobactam?

A

CAP and HAP/VAP

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11
Q

What is the benefit of using Ceftriaxone in patients with kidney diseases?

A

It is not eliminated by the kidney, so the dose does not need to be adjusted for renal impairment

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12
Q

What class of drugs can cause bleeding tendencies?

A

Cephalosporins

(cefmetazole, cefoperazone, cefotetan, ceftriaxone)

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13
Q

What are the third and fourth generation parenteral cephalosporins?

A

Ceftriaxone (3rd)

Cefepime (4th)

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14
Q

What are the third generation oral cephalosporins

A

Cefditoren

Cefpodoxime-Proxetil

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15
Q

What are the clinical applications for Cefpodoxime?

A

COPD

OM

CAP outpatient tx

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16
Q

What are the clinical applications for Cefditoren?

A

exerbation of chonric bronchitis

CAP

pharyngitis

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17
Q

Are Cefpodoxime and Cefditoren orally active?

What is the 1/2 life?

Are there any drug-drug interactions?

A

Yes

2-3 hours and 1.6hrs, increased with worsening renal function

Yes

18
Q

What are some concerning adverse effects of Cefpodoxime and Cefditoren?

A

B-lactam allergies

Superinfection (C.diff)

19
Q

Which drug class is bacteriostatic at the 30S subunit ?

A

Tetracyclines

Kills bacteria that lack cell walls (Mycoplasma pneumonia)

20
Q

Which tetracycline is the drug of choice for CAP?

A

Doxycycline

21
Q

Who should not receive Tetracyclines and why?

A

Don’t use in children due to risk of teeth staining

22
Q

What things interfere with tetracycline absorption?

What is recommended to avoid GI upset?

Should it be combined with bactericidal drugs (PNC)?

A

Antacids (Aluminum, Ca, Mg, Fe) and dairy products

Take with water

No, generally not recommended

23
Q

Which drug class binds to the 50S subunit and blocks elongation and is BacterioStatic ?

A

Macrolides (Erythromycin)

24
Q

What are the macrolide drug of choice for CAP?

A

Azithromycin

Clarithromycin

25
Q

Macrolides are effective against which bugs?

A

Most Aerobic and anaerobic gram + bugs

Not Gram negatives except: Pasturella, Haemophilus, Neisseria

Legionella, Mycoplasma, mycobacteria, rickettsia, chlamydia

No fungi

26
Q

Which drug is a well knwon inhibitor of cytochrome P450?

A

Erythromycin

increases concentration of other drugs

27
Q

Which drug causes less GI upset, erythromycin or clarithromycin?

A

Clarithromycin causes LESS GI upset

28
Q

Unlike Erythromycin, which macrolide does NOT disrupt CP450?

A

Azithromycin

concentrates in cells and slowly releases bacteriostatic levels over 2-4 days (1/2 life)

29
Q

Which drug class is broad-spectrum, administered orally, and is more effective than tetracyclines or macrolides for PNA?

A

Fluoroquinolones (-Oxacins)

Use as LAST RESORT to minimize tolerance

30
Q

What is the main adverse effect of Fluoroquinolones?

A

Tendon rupture, especially Achille’s Tendon in elderly, children, and those at risk

31
Q

What are the indications for Vancomycin?

What can infusing too fast cause?

A

MRSA, MRSE, serious allergy to PNC

C. diff

Red Man Syndrome

32
Q

Which drug binds to ribosomal A to prevent tRNA binding, thus inhibiting the first step of protein synthesis

A

Linozolid

33
Q

What are the clinical applications of Linezolid?

A

VRE

CAP (methicillin susceptible) and HAP (methicillin-susceptible and resistant)

34
Q

Linezolid can be administered which two ways?

It inhibits which important enzyme, leading to which side effects?

A

Oral and IV

MAO–> neurologic sx, serotonin syndrome

35
Q

What is the MOA of Aztreonam?

What is it effective against?

A

inhibits bacterial cell wall synthesis by binding to PBP

Gram -, including Pseudomonas

No use against Gram + or anearobes

36
Q

What is the MOA of Imipenem?

What is it effective against?

A

inhibits bacterial cell wall synthesis by binding to PBP

Wide spectrum of G+ and G-, aerobes and anaerobes, many MDR strains

37
Q

What is the main clinical application of Imipenem?

A

lower respiratory tract infections

38
Q

Gentamicin binds to which ribosomal subunit thus inhibiting growth?

What is Gentamicin used for?

A

30S subunit

Respiratory tract infections?

39
Q

What are the main toxicities of Gentamicin?

A

Nephrotoxicity

Neurotoxicity

Ototoxicity

40
Q

What drug used to be the drug of choice for aspiration PNA but now is associated with C. diff?

A

Clindamycin

41
Q

What bugs undergo post-translational modifications that give rise to antibiotic resistance?

(mnemonic)

A

ESKAPE

E. Coli

Staphylococcus

Klebsiella

Acinetobacter

Pseudomonas

Enteroccocus

2020 CPR II Pulm Exam 2 (28 decks)

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