Pharmacology- Caldwell Flashcards
This type of evidence is obtained from at least one properly designed randomized controlled tria
Level 1
Describe Level III evidence
Opinions of respected authorities, based on clinical experience, descriptive studies or reports of expert committees
Which type of evidence is better, Level I or Level III
Level I
Name 3 antibiotics with level I evidence for S. Pneumoniae in outpatient setting with no risk factors
MACROLIDES
Azithromycin, clarithromycin, erythromycin
Name 3 antibiotics with level I evidence for S. Pneumoniae in outpatient setting with comorbidities
RESPIRATORY FLUOROQUINOLONES
Moxifloxacin, gemifloxacin, or levofloxacin
What is an alternative treatment route for S. Pneumoniae in outpatient setting with comorbidities
Beta-lactam plus a macrolide
Preferred: Amoxicillin or amoxicillin-clavulanate (can substitute ceftriaxone, cefpodoxime, and cefuroxime)
What is the monotherapy with level I evidence for inpatient, non-ICU, CAP?
Respiratory fluoroquinolones
Moxifloxacin, gemifloxacin, or levofloxacin
What is the combination therapy with level I evidence for inpatient, non-ICU, CAP?
Beta-lactams (cefotaxime, ceftriaxone, ampicillin-ertapenem) & a macrolide
If the patient is allergic to penicillin, what do you substitute the beta-lactam for?
Fluoroquinolones
Why isn’t ciprofloxacin used for CAP?
It doesn’t cover S. Pneumonia (most common cause of CAP)
What category of antibiotic with level I evidence is used for CAP in the ICU?
Respiratory fluoroquinolones
Moxifloxacin, gemifloxacin, or levofloxacin
What are the 2 drugs used initially for acute sinusitis
Amoxicillin and TMP-SMX
What bugs are amoxicillin less effective against?
H. influenzae and M. catarrhalis
What bug is TMP-SMX less effective against?
S. Pneumoniae
List the agents effective against chronic sinusitis
Amoxicillin clavulanate (Augmentin), cefuroxime, clarithromycin, azithromycin, clindamycin, cefpodoxime, cefprozil
What is the IM antibiotic used for Streptococcus pharyngitis?
One dose of penicillin G
What is the oral antibiotic used for Streptococcus pharyngitis?
Penicillin V for 10 days
What do you give for Streptococcus pharyngitis if the patient is allergic to penicillin?
Erythromycin: Estolate or ethylsuccinate
Antibiotics for COPD?
TMP-SMX, doxycycline, azithromycin/clarithromycin
What do you give for pneumonia caused by highly penicillin-resistant S. Pneumoniae?
Doxycycline, clindamycin, levofloxacin
What antibiotics are used for pneumonia caused by Legionella?
Azithromycin and fluoroquinolone
Can also use tigecycline
4 specific antibiotics for CAP in patients older than 60?
2nd gen cephalosporins:
Loracarbef and cefuroxime axetil
3rd gen cephalospoorins:
Cefpodoxime and ceftriaxone
What do you need to be careful with in H. influenza and Klebsiella pneumonia in choosing an antibiotic?
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 -)
What are the 3 antibiotics used against HAP caused by MRSA?
Linezolid or vancomycin
Also tigecycline
What are 4 reasons mycobacteria are intrinsically resistant to most antibiotics?
- Slow growth (anything active against growing cells won’t work with this)
- Can be dormant
- Their lipid-rich cell wall can be impermeable
- They are intracellular and inaccessible to drugs that can’t penetrate macrophages
What are the 5 first line drugs used for TB?
Isoniazid, rifampin, pyrazinamide, ethambutol, streptomycin
Which two TB drugs are the most active?
Isoniazid, rifampin
MOA of isoniazid?
Inhibits synthesis of mycolic acids
MOA of rifampin
- Inhibits DNA-dependent RNA polymerase
- Blocks RNA production
MOA of Pyrazinamide (PZA)
- Not fully understood
- Converted to active pyrazinoic acid in macrophage lysosomes
MOA of Ethambutol?
-Inhibits mycobacterial arabinosyl transferases (involved in polymerization rxn. Of arabinoglycan – essential in cell walls)
MOA of Streptomycin?
Binds to S12 ribosomal subunit → prevents bacterial protein synthesis
Clinical Indications of isoniazid?
- 1st line for TB
- Tx of latent infection (single drug)
- Less active against other mycobacteria
Clinical indications of rifampin?
- 1st line for TB
- Atypical mycobacterial infections
- Eradication of meningococcal colonization, Staph. infections
- Prophylaxis for H-flu
Clinical indications of pyrazinamide?
- “Sterilizing” agent used during 1st 2 mths. Of therapy
- Allows total duration of therapy to be ↓ to 6 mths.
Clinical indications of ethambutol?
- Given as 4-drug initial combo. Therapy for TB until drug sensitivities are known
- Atypical mycobacterial infection
Clinical indications of streptomycin?
- In TB when injectable drug is needed or desirable
- Tx of drug-resistant strain
AE of isoniazid?
- Hepatotoxicity
- Peripheral neuropathy (give pyridoxine to prevent)
- Fever
- Skin rashes
AE of Rifampin?
- Rash
- Nephritis
- Thrombocytopenia
- Cholestasis
- Flu-like Sx
- Turns body fluids orange (harmless)
AE of Pyrazinamide?
- Hepatotoxicity
- Hyperuricemia
- N/V, drug fever
AE of Ethambutol?
-Retrobulbar neuritis → loss of visual acuity & re-green color blindness
AE of Streptomycin?
-Nephrotoxicity • ototoxicity
Resistance to Isoniazid?
-When used as single drug in Tx of active infection -Mutation → overexpression of inhA, depletion of katG, overexpression of ahpC, or kasA
Resistance to Rifampin?
-When used as single drug in Tx of active infection -Mutation in rpoB
Resistance to Pyrazinamide?
- Impaired uptake
- Mutations in pncA (impaired conversion to active form)
Resistance to Ethambutol?
When used as single drug in Tx
-Mutations → overexpression of emb
Resistance to Streptomycin?
-Non-TB Mycobacteria (except MAC & M. kansasii) -Mutation in rpsL or rrs
