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Respiratory Exam 2 > Pharmacology of Bacterial Pneumonia > Flashcards

Pharmacology of Bacterial Pneumonia Flashcards

1
Q

empiric treatment of community acquired pneumonia in outpatient who is:
- healthy, no antibiotic use within 90 days

A
  • macrolide
    OR
  • doxycycline
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2
Q

what pathogen classes do macrolides treat?

A
  • gram positive
  • H. flu (gram negative)
  • atypicals
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3
Q

side effects of erythromycin

what drug is preferred?

A
  • GI distress
  • ineffective against H. flu
  • azithromycin preferred
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4
Q

macrolide toxicities

A
  • prolonged QT interval

- drug interactions

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5
Q

what other drugs could your patient be taking that you need to watch out for if they may also cause a prolonged QT interval?

A
  • quinidine - class Ia
  • procainamide - class Ia
  • amiodarine - class III
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6
Q

which macrolide does not participate in drug interactions

A
  • azithromycin
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7
Q

MOA of macrolide drug interactions

what drug in particular does it not interact with well

A
  • inhibit CYP3A4 which decreases metabolism of drugs and increases their serum concentration
  • warfarin
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8
Q

other effects of macrolides

A
  • immunomodulatory/anti-inflammatory
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9
Q

what pathogen classes does doxycycline treat?

A
  • gram positives/negatives

- atypicals

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10
Q

toxicities of doxycycline

A
  • prolonged QT interval
  • photosensitivity (DOXY PHOTO)
  • tooth discoloration
  • pharmacokinetic issues (DOXY DIVALENT)
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11
Q

can you use macrolides in pregnancy

A
  • yes
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12
Q

can you use doxycycline in pregnancy

A
  • no
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13
Q

pharmacokinetic issues with doxycycline

A
  • potent binder of divalent and trivalent cations and becomes insoluble
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14
Q

avoid taking doxycycline with

A
  • antacids
  • dietary supplements
  • milk/dairy products
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15
Q

empiric treatment of community acquired pneumonia in outpatient who has:
- comorbidities or antibiotic use within 90 days

A
  • fluoroquinolone
    OR
  • beta lactam + macrolide
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16
Q

what pathogen classes do beta lactams treat?

A
  • gram positives/negatives
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17
Q

what is one thing to avoid in a patient who has taken antibiotics within 90 days

A
  • avoid use of drugs in the same category as prior use
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18
Q

risks of use of beta lactam and macrolides in a patient who has used antibiotics within 90 days

A
  • resistance has been noted
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19
Q

which drug is not classified as a respiratory fluoroquinolone?

why?

A
  • ciprofloxacin

- it is not effective against Strep pneumonia

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20
Q

what pathogen classes do fluoroquinolones treat?

A
  • gram positive/negative

- atypicals

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21
Q

toxicities of fluoroquinolones

A
  • prolonged QT
  • nephrotoxicity/interstitial nephritis
  • tendon rupture
  • drug interactions
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22
Q

do we use fluoroquinolones in pregnancy

A
  • as a last resort
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23
Q

patients at what age are at most risk for a tendon rupture due to fluoroquinolone use

A
  • over 60
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24
Q

what drugs do fluoroquinolones interact with

effects

A
  • NSAIDS

- negative CNS effects - tremors, anxiety, insomnia, seizures

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25
the beta lactams recommended with macrolides in a patient who has used antibiotics within 90 days how must they be administered?
- penicillin - cephalosporins - orally
26
toxicities of beta lactams
- allergy/hypersensitivity | - nephrotoxicity/interstitial nephritis
27
types of hypersensitivity of beta lactams
- type I (IgE mediated - true allergy) - type II (IgG mediated) - type IV
28
commonality of type I hypersensitivity of beta lactams
- rare
29
commonality of type II hypersensitivity of beta lactams
- common
30
rate of onset of type I hypersensitivity of beta lactams
- rapid (minutes/hours)
31
rate of onset of type II hypersensitivity of beta lactams
- slow (days)
32
symptoms of type I hypersensitivity of beta lactams
- anaphylaxis - hypotension - bronchospasm - angioedema LIFE THREATENING
33
symptoms of type II hypersensitivity of beta lactams
- inflammation - fever - arthralgia NON LIFE THREATENING
34
symptoms of type IV hypersensitivity of beta lactams
- Steven's Johnson Syndrome | - fatal form of topic epidermal necrolysis
35
which beta lactam does not produce hypersensitivity reactions
- Aztreonam
36
nephrotoxocity/interstital nephritis of beta lactams limited to
- penicillins - 1st generation cephalosporins - later generations at high doses
37
empiric treatment of community acquired pneumonia in outpatient who has: - high rate of macrolide resistant S. pneumo
- fluoroquinolone OR - beta lactam + macrolide
38
empiric treatment of community acquired pneumonia in inpatient non-ICU
- fluoroquinolone OR - beta lactam + macrolide
39
what beta lactams do we use for inpatient ICU patients when we recommend beta lactams
- cephalosporins - penicillins - DIFFERENT ONES FROM THE OTHER GROUP
40
empiric treatment of community acquired pneumonia in inpatient ICU
- beta lactam + azithromycin OR - beta latam + fluoroquinolone
41
azithromycin works on which pathogen classes
- gram positive - H. flu - atypicals
42
for all patients admitted to the ICU, coverage for ______ and ________ species should be ensured
- S. pneumoniae | - Legionella
43
empiric treatment of community acquired pneumonia in inpatient ICU IF PATIENT HAS A PENICILLIN HYPERSENSITIVITY
- aztrenoam + fluoroquinolone
44
empiric treatment of community acquired pneumonia if patient has pseudomonas
- beta lactam + fluoroquinolone OR - beta lactam + aminoglycoside + fluoroquinolone
45
empiric treatment of community acquired pneumonia if patient has MRSA
- vancomycin OR - linezolid
46
which beta lactams do you use in empiric treatment of community acquired pneumonia if patient has pseudomonas
- the ones that are anti-pseudomonals
47
toxicities of carbapenems
- seizures
48
how do carbapenems cause seizures
- inhibit GABA receptors in the brain
49
toxicities of aminoglycosides reversibility
- hearing loss (irreversible) - nephrotoxicity/tubular injury (reversible) A MEE NO HEAR NO MORE
50
can you use Aminoglycosides in pregnancy
- no
51
toxicities of vancomycin
- nephrotoxicity/interstitial nephritis - ototoxicity - red man syndrome
52
how does vancomycin cause red man syndrome
- non-specific mast cell degranulation (histamine release)
53
toxicities of linezolid reversibility
- myelosuppression (thrombocytopenia) (reversible) | - sertonergic drug interactions
54
thrombocytopenia with linezolid occurs with what kind of use
- long term use
55
how linezolid interacts with serotonergic drugs
- slows degradation of serotonin via MAOI | - causes Serotonin syndrome
56
antibiotics for HAP/VAP should cover ________ and _________
- S. aureus | - P. aeruginosa
57
HAP/VAP when drug resistant strains are not suspected, what do you use?
- broad spectrum and anti-pseudomonals
58
HAP/VAP when MRSA and sensitive pseudomonas are suspected, what do you use?
- use one drug for each
59
HAP/VAP when MDR Pseudomonas and susceptible Staph aureus are suspected
- double coverage with two antipseudomonals | - use beta lactam and non beta lactam from different functional classes
60
HAP/VAP when MDR Pseudomonas and MRSA are suspected
- double coverage with two antipseudomonals - use beta lactam and non beta lactam from different functional classes - + MRSA treatment
61
MOA of colistin
- disrupts outer and inner membranes of gram negative bacteria
62
toxicities of colistin
- nephrotoxicity at high doses - interference with NMJ signaling (weakness, apnea) - peripheral nerve damage, paresthesia
63
key anaerobic bacteria genuses
- bacteriodes - prevotella - fusobacterium - peptostreptococcus
64
clindamycin effective against
- gram negative and gram positive microbes
65
toxicities of clindamycin
- pseudomembranous colities | - superinfection of C. diff

Respiratory Exam 2 (18 decks)

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