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Respiratory II > Pharmacology- Caldwell > Flashcards

Pharmacology- Caldwell Flashcards

1
Q

This type of evidence is obtained from at least one properly designed randomized controlled tria

A

Level 1

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2
Q

Describe Level III evidence

A

Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees

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3
Q

Which type of evidence is better, Level I or Level III

A

Level I

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4
Q

Name 3 antibiotics with level I evidence for S. Pneumoniae in outpatient setting with no risk factors

A

MACROLIDES

Azithromycin, clarithromycin, erythromycin

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5
Q

Name 3 antibiotics with level I evidence for S. Pneumoniae in outpatient setting with comorbidities

A

RESPIRATORY FLUOROQUINOLONES

Moxifloxacin, gemifloxacin, or levofloxacin

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6
Q

What is an alternative treatment route for S. Pneumoniae in outpatient setting with comorbidities

A

Beta-lactam plus a macrolide

Preferred: Amoxicillin or amoxicillin-clavulanate (can substitute ceftriaxone, cefpodoxime, and cefuroxime)

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7
Q

What is the monotherapy with level I evidence for inpatient, non-ICU, CAP?

A

Respiratory fluoroquinolones

Moxifloxacin, gemifloxacin, or levofloxacin

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8
Q

What is the combination therapy with level I evidence for inpatient, non-ICU, CAP?

A

Beta-lactams (cefotaxime, ceftriaxone, ampicillin-ertapenem) & a macrolide

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9
Q

If the patient is allergic to penicillin, what do you substitute the beta-lactam for?

A

Fluoroquinolones

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10
Q

Why isn’t ciprofloxacin used for CAP?

A

It doesn’t cover S. Pneumonia (most common cause of CAP)

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11
Q

What category of antibiotic with level I evidence is used for CAP in the ICU?

A

Respiratory fluoroquinolones

Moxifloxacin, gemifloxacin, or levofloxacin

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12
Q

What are the 2 drugs used initially for acute sinusitis

A

Amoxicillin and TMP-SMX

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13
Q

What bugs are amoxicillin less effective against?

A

H. influenzae and M. catarrhalis

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14
Q

What bug is TMP-SMX less effective against?

A

S. Pneumoniae

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15
Q

List the agents effective against chronic sinusitis

A

Amoxicillin clavulanate (Augmentin), cefuroxime, clarithromycin, azithromycin, clindamycin, cefpodoxime, cefprozil

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16
Q

What is the IM antibiotic used for Streptococcus pharyngitis?

A

One dose of penicillin G

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17
Q

What is the oral antibiotic used for Streptococcus pharyngitis?

A

Penicillin V for 10 days

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18
Q

What do you give for Streptococcus pharyngitis if the patient is allergic to penicillin?

A

Erythromycin: Estolate or ethylsuccinate

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19
Q

Antibiotics for COPD?

A

TMP-SMX, doxycycline, azithromycin/clarithromycin

20
Q

What do you give for pneumonia caused by highly penicillin-resistant S. Pneumoniae?

A

Doxycycline, clindamycin, levofloxacin

21
Q

What antibiotics are used for pneumonia caused by Legionella?

A

Azithromycin and fluoroquinolone

Can also use tigecycline

22
Q

4 specific antibiotics for CAP in patients older than 60?

A

2nd gen cephalosporins:
Loracarbef and cefuroxime axetil
3rd gen cephalospoorins:
Cefpodoxime and ceftriaxone

23
Q

What do you need to be careful with in H. influenza and Klebsiella pneumonia in choosing an antibiotic?

A 
It needs to be beta-lactamase stable
These ones are...!
2nd gen cephalosporins:
Loracarbef and cefuroxime axetil
3rd gen cephalospoorins:
Cefpodoxime and ceftriaxone 
(They also cover gram + and gram -)
24
Q

What are the 3 antibiotics used against HAP caused by MRSA?

A

Linezolid or vancomycin

Also tigecycline

25
Q

What are 4 reasons mycobacteria are intrinsically resistant to most antibiotics?

A
  1. Slow growth (anything active against growing cells won’t work with this)
  2. Can be dormant
  3. Their lipid-rich cell wall can be impermeable
  4. They are intracellular and inaccessible to drugs that can’t penetrate macrophages
26
Q

What are the 5 first line drugs used for TB?

A

Isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin

27
Q

Which two TB drugs are the most active?

A

Isoniazid, rifampin

28
Q

MOA of isoniazid?

A

Inhibits synthesis of mycolic acids

29
Q

MOA of rifampin

A
  • Inhibits DNA-dependent RNA polymerase

- Blocks RNA production

30
Q

MOA of Pyrazinamide (PZA)

A
  • Not fully understood

- Converted to active pyrazinoic acid in macrophage lysosomes

31
Q

MOA of Ethambutol?

A

-Inhibits mycobacterial arabinosyl transferases (involved in polymerization rxn. Of arabinoglycan – essential in cell walls)

32
Q

MOA of Streptomycin?

A

Binds to S12 ribosomal subunit → prevents bacterial protein synthesis

33
Q

Clinical Indications of isoniazid?

A
  • 1st line for TB
  • Tx of latent infection (single drug)
  • Less active against other mycobacteria
34
Q

Clinical indications of rifampin?

A
  • 1st line for TB
  • Atypical mycobacterial infections
  • Eradication of meningococcal colonization, Staph. infections
  • Prophylaxis for H-flu
35
Q

Clinical indications of pyrazinamide?

A
  • “Sterilizing” agent used during 1st 2 mths. Of therapy

- Allows total duration of therapy to be ↓ to 6 mths.

36
Q

Clinical indications of ethambutol?

A
  • Given as 4-drug initial combo. Therapy for TB until drug sensitivities are known
  • Atypical mycobacterial infection
37
Q

Clinical indications of streptomycin?

A
  • In TB when injectable drug is needed or desirable

- Tx of drug-resistant strain

38
Q

AE of isoniazid?

A
  • Hepatotoxicity
  • Peripheral neuropathy (give pyridoxine to prevent)
  • Fever
  • Skin rashes
39
Q

AE of Rifampin?

A
  • Rash
  • Nephritis
  • Thrombocytopenia
  • Cholestasis
  • Flu-like Sx
  • Turns body fluids orange (harmless)
40
Q

AE of Pyrazinamide?

A
  • Hepatotoxicity
  • Hyperuricemia
  • N/V, drug fever
41
Q

AE of Ethambutol?

A

-Retrobulbar neuritis → loss of visual acuity & re-green color blindness

42
Q

AE of Streptomycin?

A

-Nephrotoxicity • ototoxicity

43
Q

Resistance to Isoniazid?

A

-When used as single drug in Tx of active infection -Mutation → overexpression of inhA, depletion of katG, overexpression of ahpC, or kasA

44
Q

Resistance to Rifampin?

A

-When used as single drug in Tx of active infection -Mutation in rpoB

45
Q

Resistance to Pyrazinamide?

A
  • Impaired uptake

- Mutations in pncA (impaired conversion to active form)

46
Q

Resistance to Ethambutol?

A

When used as single drug in Tx

-Mutations → overexpression of emb

47
Q

Resistance to Streptomycin?

A

-Non-TB Mycobacteria (except MAC & M. kansasii) -Mutation in rpsL or rrs

Respiratory II (8 decks)

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