Pulm: Drugs for Pneumonia (CAP, HAP, VAP) Flashcards
Identify the bug: rust colored sputum
strep pneumo
Identify the bug: currant jelly sputum
Klebsiella
Identify the bug: cultured on chocolate agar
Haemophilus and Neisseria
Identify the bug: smells like grapes
pseudomonas
Identify the bug: Flowery smell
E. coli, H. flu
Identify the bug: semen like odor
Moraxella catarrhalis
Identify the bug: Yeasty
Candida
Identify the bug: dirty gym socks
Acinectobacter baumannii
Identify the bug: rotten chicken soup, or chocolate cake
Proteus
Identify the bug: earthy, musty, dirt
Actinomyces, streptomyces, nocardia
Identify the bug: very bad breath
Gram (-) anaerobes
Identify the bug: Very young or old pts
viral
MOA and coverage of vancomycin
inhibits cell wall synthesis by directly binding D-alanyl- D-alanine oligopeptides
Gram (+) (especially MRSA)
MOA of B-lactams
Binds to PBP and prevents cross-linking of bacterial cell wall
MOA and Coverage of Aminoglycosides
bind irreversibly to the 30S ribosomal subunit, inhibiting formation of initiation complex
Gram (-)
MOA and coverage of tetracyclines
bind reversibly to the bacterial 30S ribosomal subunit
Broad Spectrum
MOA and coverage of Macrolides
acts on the bacterial 50S ribosomal subunit, inhibiting translocation
MOA of lefamulin
Blocks elongation of the bacterial proteins
-specifically for CAP w normal lungs
low resistance=works when others don’t
MOA of Floroquinalones (for gram (+) and (-))
Gram (-)=inhibits DNA Gyrase (topo II)
Gram (+)=inhibits topoisomerase IV
How would you treat CAP in someone without comorbidities and without a PCN allergy?
Amoxacillin+Macrolide (preferred) or Doxycycline
How would you treat CAP in someone with comorbidities and without a PCN allergy?
Amoxacillin-clavulonic acid+Macrolide (preferred) or Doxycycline
How would you treat CAP in someone w PCN allergy?
3rd gen Cephalosporin (ceftriaxone)+ macrolide or doxycycline
How would you treat CAP in someone w PCN allergy and cannot use cepholosporins?
Respiratory floroquinolone or lefamulin
How would you treat CAP in someone who has structural lung disease and a PCN allergy and cannot use cepholosporins?
Respiratory floroquinolones
When is lefamulin contraindicated?
In a pt with structural lung disease
-only for healthy lungs
Adverse reactions to penicillins?
Allergic Rxns
-contact dermatitis, urticaria, rash, fever, prutitis
What penicillinase resistant penicillin is great for Staph aureus?
Nafcillin
What are the broad spectrum penicillins that are great for gram (-)?
Ampicillin/amoxicillin
-not effective against pseudomonas
What are the extended spectrum penicillins that are good to treat P. aeruginosa?
Piperacillin, ticarcillin
What are the penicillins combined with, to increase activity?
Beta-lactamase inhibitors
-clavulanate, tazobactam, sulbactam
Adverse reactions to Amoxicillin+clavulanate?
Anaphylaxis
Superinfection (C. diff)
What is amoxicillin-clavulanate effective agaisnt?
Gram - and +, but NOT pseudomonas
What is piperacillin+tazobactam effective agaisnt?
Gram - and +, including pseudomonas**
Clinical applications for piperacillin+tazobactam?
CAP and HAP/VAP
Adverse rxns to piperacillin+tazobactam?
SJS and other hypersensitivities
Superinfection
1st gen cephalosporins + coverage
Cefazolin, Cephalexin
Gram (+)
2nd gen cephalosporins + coverage
Cefotetan, cefoxitin
Gram (-)
3rd gen cephalosporins + coverage
Ceftriaxone, cefpodoxime
Gram (-)
4th gen cephalosporins + coverage
Cefepime
Gram (+) and Gram (-)
5th gen cephalosporins + coverage
Ceftaroline
Gram (+) and Gram (-)
What is noteworthy about Ceftriaxones elimination compared to the other cephalosporins?
It is not eliminated by kidney, so no dose adjustment if renal issues
Which four cephalosporins cause bleeding issues?
Cefmetazole, cefoperazone, cefotetan, ceftriaxone
What are the parenteral cephalosporins?
Ceftriaxone (3rd)
Cefepime (4th)
What are the oral cephalosporins?
Cefditoren and Cefpodoxime (3rd)
Which antibiotics are great for bacteria without a cell wall?
Tetracyclines
-mycoplasma pneumonia
What is an issue with prescribing tetracyclines in kids?
Deposits into teeth and bones, causing gray discoloration
What can impair absorption of tetracyclines?
Dicationic metals
-Mg, Ca, Al, Fe
What antibiotics are great for atypical pneumonia (legionella, mycoplasma, chlamydia)?
Macrolides
-azithromycin or clarithromycin
Which macrolide does NOT inhibit CYP450?
Azithromycin
Erythro and Clarithro do!
Which macrolide causes pretty bad GI pain?
Erythromycin
Which macrolide can be given as a single dose, slow release?
Azithromycin
What drugs are the respiratory floroquinolones?
Levofloxacin, Gemifloxacin, and Moxifloxacin
Broad spectrum, reserved last resort
What toxicity is important for fluoroquinolones?
Achille’s tendon rupture
Which drug is great for MRSA and MRSE, but can cause Red-man syndrome?
Vancomycin
MOA and coverage of Linezolid
binds 23s RNA of 50S subunit
Gram (+)-Great for VRE
Adverse effects of linezolid?
Blocks monoamine oxidase, so can have increase in serotonin (serotonin syndrome)
Lactic acidosis, thrombocytopenia, peripheral neuropathy, hypoglycemia in diabetics
MOA and Coverage of Aztreonam
Penicillin-Binding-Protein (PBP) that blocks bacterial cell wall synthesis
Gram (-)
MOA and Coverage of Imipenem
Penicillin-Binding-Protein (PBP) that blocks bacterial cell wall synthesis
Broad spectrum
-last resort!
Adverse effects of imipenem?
CNS effects: seizures, confusion
MOA and coverage of gentamicin
bind irreversibly to the 30S ribosomal subunit, inhibiting formation of initiation complex
Mostly Gram (-), but also staph (+)
Adverse effects of gentamicin?
Nephrotoxicity, Neurotoxicity, Ototoxicity
What are the hard to kill bugs? ESKAP(e)
Enterobacter S. aureus Klebsiella A. baumannii P. aeruginosa
Have post-translational modifications that provide resistance
