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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
Q

the beta lactams recommended with macrolides in a patient who has used antibiotics within 90 days

how must they be administered?

A
  • penicillin
  • cephalosporins
  • orally
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26
Q

toxicities of beta lactams

A
  • allergy/hypersensitivity

- nephrotoxicity/interstitial nephritis

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27
Q

types of hypersensitivity of beta lactams

A
  • type I (IgE mediated - true allergy)
  • type II (IgG mediated)
  • type IV
28
Q

commonality of type I hypersensitivity of beta lactams

A
  • rare
29
Q

commonality of type II hypersensitivity of beta lactams

A
  • common
30
Q

rate of onset of type I hypersensitivity of beta lactams

A
  • rapid (minutes/hours)
31
Q

rate of onset of type II hypersensitivity of beta lactams

A
  • slow (days)
32
Q

symptoms of type I hypersensitivity of beta lactams

A
  • anaphylaxis
  • hypotension
  • bronchospasm
  • angioedema

LIFE THREATENING

33
Q

symptoms of type II hypersensitivity of beta lactams

A
  • inflammation
  • fever
  • arthralgia

NON LIFE THREATENING

34
Q

symptoms of type IV hypersensitivity of beta lactams

A
  • Steven’s Johnson Syndrome

- fatal form of topic epidermal necrolysis

35
Q

which beta lactam does not produce hypersensitivity reactions

A
  • Aztreonam
36
Q

nephrotoxocity/interstital nephritis of beta lactams limited to

A
  • penicillins
  • 1st generation cephalosporins
  • later generations at high doses
37
Q

empiric treatment of community acquired pneumonia in outpatient who has:
- high rate of macrolide resistant S. pneumo

A
  • fluoroquinolone
    OR
  • beta lactam + macrolide
38
Q

empiric treatment of community acquired pneumonia in inpatient non-ICU

A
  • fluoroquinolone
    OR
  • beta lactam + macrolide
39
Q

what beta lactams do we use for inpatient ICU patients when we recommend beta lactams

A
  • cephalosporins
  • penicillins
  • DIFFERENT ONES FROM THE OTHER GROUP
40
Q

empiric treatment of community acquired pneumonia in inpatient ICU

A
  • beta lactam + azithromycin
    OR
  • beta latam + fluoroquinolone
41
Q

azithromycin works on which pathogen classes

A
  • gram positive
  • H. flu
  • atypicals
42
Q

for all patients admitted to the ICU, coverage for ______ and ________ species should be ensured

A
  • S. pneumoniae

- Legionella

43
Q

empiric treatment of community acquired pneumonia in inpatient ICU IF PATIENT HAS A PENICILLIN HYPERSENSITIVITY

A
  • aztrenoam + fluoroquinolone
44
Q

empiric treatment of community acquired pneumonia if patient has pseudomonas

A
  • beta lactam + fluoroquinolone
    OR
  • beta lactam + aminoglycoside + fluoroquinolone
45
Q

empiric treatment of community acquired pneumonia if patient has MRSA

A
  • vancomycin
    OR
  • linezolid
46
Q

which beta lactams do you use in empiric treatment of community acquired pneumonia if patient has pseudomonas

A
  • the ones that are anti-pseudomonals
47
Q

toxicities of carbapenems

A
  • seizures
48
Q

how do carbapenems cause seizures

A
  • inhibit GABA receptors in the brain
49
Q

toxicities of aminoglycosides

reversibility

A
  • hearing loss (irreversible)
  • nephrotoxicity/tubular injury (reversible)

A MEE NO HEAR NO MORE

50
Q

can you use Aminoglycosides in pregnancy

A
  • no
51
Q

toxicities of vancomycin

A
  • nephrotoxicity/interstitial nephritis
  • ototoxicity
  • red man syndrome
52
Q

how does vancomycin cause red man syndrome

A
  • non-specific mast cell degranulation (histamine release)
53
Q

toxicities of linezolid

reversibility

A
  • myelosuppression (thrombocytopenia) (reversible)

- sertonergic drug interactions

54
Q

thrombocytopenia with linezolid occurs with what kind of use

A
  • long term use
55
Q

how linezolid interacts with serotonergic drugs

A
  • slows degradation of serotonin via MAOI

- causes Serotonin syndrome

56
Q

antibiotics for HAP/VAP should cover ________ and _________

A
  • S. aureus

- P. aeruginosa

57
Q

HAP/VAP when drug resistant strains are not suspected, what do you use?

A
  • broad spectrum and anti-pseudomonals
58
Q

HAP/VAP when MRSA and sensitive pseudomonas are suspected, what do you use?

A
  • use one drug for each
59
Q

HAP/VAP when MDR Pseudomonas and susceptible Staph aureus are suspected

A
  • double coverage with two antipseudomonals

- use beta lactam and non beta lactam from different functional classes

60
Q

HAP/VAP when MDR Pseudomonas and MRSA are suspected

A
  • double coverage with two antipseudomonals
  • use beta lactam and non beta lactam from different functional classes
    • MRSA treatment
61
Q

MOA of colistin

A
  • disrupts outer and inner membranes of gram negative bacteria
62
Q

toxicities of colistin

A
  • nephrotoxicity at high doses
  • interference with NMJ signaling (weakness, apnea)
  • peripheral nerve damage, paresthesia
63
Q

key anaerobic bacteria genuses

A
  • bacteriodes
  • prevotella
  • fusobacterium
  • peptostreptococcus
64
Q

clindamycin effective against

A
  • gram negative and gram positive microbes
65
Q

toxicities of clindamycin

A
  • pseudomembranous colities

- superinfection of C. diff

Respiratory Exam 2 (18 decks)

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