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Pharmacology > Pulm: Drugs for Pneumonia (CAP, HAP, VAP) > Flashcards

Pulm: Drugs for Pneumonia (CAP, HAP, VAP) Flashcards

1
Q

Identify the bug: rust colored sputum

A

strep pneumo

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2
Q

Identify the bug: currant jelly sputum

A

Klebsiella

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3
Q

Identify the bug: cultured on chocolate agar

A

Haemophilus and Neisseria

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4
Q

Identify the bug: smells like grapes

A

pseudomonas

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5
Q

Identify the bug: Flowery smell

A

E. coli, H. flu

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6
Q

Identify the bug: semen like odor

A

Moraxella catarrhalis

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7
Q

Identify the bug: Yeasty

A

Candida

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8
Q

Identify the bug: dirty gym socks

A

Acinectobacter baumannii

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9
Q

Identify the bug: rotten chicken soup, or chocolate cake

A

Proteus

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10
Q

Identify the bug: earthy, musty, dirt

A

Actinomyces, streptomyces, nocardia

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11
Q

Identify the bug: very bad breath

A

Gram (-) anaerobes

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12
Q

Identify the bug: Very young or old pts

A

viral

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13
Q

MOA and coverage of vancomycin

A

inhibits cell wall synthesis by directly binding D-alanyl- D-alanine oligopeptides

Gram (+) (especially MRSA)

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14
Q

MOA of B-lactams

A

Binds to PBP and prevents cross-linking of bacterial cell wall

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15
Q

MOA and Coverage of Aminoglycosides

A

bind irreversibly to the 30S ribosomal subunit, inhibiting formation of initiation complex

Gram (-)

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16
Q

MOA and coverage of tetracyclines

A

bind reversibly to the bacterial 30S ribosomal subunit

Broad Spectrum

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17
Q

MOA and coverage of Macrolides

A

acts on the bacterial 50S ribosomal subunit, inhibiting translocation

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18
Q

MOA of lefamulin

A

Blocks elongation of the bacterial proteins
-specifically for CAP w normal lungs

low resistance=works when others don’t

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19
Q

MOA of Floroquinalones (for gram (+) and (-))

A

Gram (-)=inhibits DNA Gyrase (topo II)

Gram (+)=inhibits topoisomerase IV

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20
Q

How would you treat CAP in someone without comorbidities and without a PCN allergy?

A

Amoxacillin+Macrolide (preferred) or Doxycycline

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21
Q

How would you treat CAP in someone with comorbidities and without a PCN allergy?

A

Amoxacillin-clavulonic acid+Macrolide (preferred) or Doxycycline

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22
Q

How would you treat CAP in someone w PCN allergy?

A

3rd gen Cephalosporin (ceftriaxone)+ macrolide or doxycycline

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23
Q

How would you treat CAP in someone w PCN allergy and cannot use cepholosporins?

A

Respiratory floroquinolone or lefamulin

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24
Q

How would you treat CAP in someone who has structural lung disease and a PCN allergy and cannot use cepholosporins?

A

Respiratory floroquinolones

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25
Q

When is lefamulin contraindicated?

A

In a pt with structural lung disease

-only for healthy lungs

26
Q

Adverse reactions to penicillins?

A

Allergic Rxns

-contact dermatitis, urticaria, rash, fever, prutitis

27
Q

What penicillinase resistant penicillin is great for Staph aureus?

A

Nafcillin

28
Q

What are the broad spectrum penicillins that are great for gram (-)?

A

Ampicillin/amoxicillin

-not effective against pseudomonas

29
Q

What are the extended spectrum penicillins that are good to treat P. aeruginosa?

A

Piperacillin, ticarcillin

30
Q

What are the penicillins combined with, to increase activity?

A

Beta-lactamase inhibitors

-clavulanate, tazobactam, sulbactam

31
Q

Adverse reactions to Amoxicillin+clavulanate?

A

Anaphylaxis

Superinfection (C. diff)

32
Q

What is amoxicillin-clavulanate effective agaisnt?

A

Gram - and +, but NOT pseudomonas

33
Q

What is piperacillin+tazobactam effective agaisnt?

A

Gram - and +, including pseudomonas**

34
Q

Clinical applications for piperacillin+tazobactam?

A

CAP and HAP/VAP

35
Q

Adverse rxns to piperacillin+tazobactam?

A

SJS and other hypersensitivities

Superinfection

36
Q

1st gen cephalosporins + coverage

A

Cefazolin, Cephalexin

Gram (+)

37
Q

2nd gen cephalosporins + coverage

A

Cefotetan, cefoxitin

Gram (-)

38
Q

3rd gen cephalosporins + coverage

A

Ceftriaxone, cefpodoxime

Gram (-)

39
Q

4th gen cephalosporins + coverage

A

Cefepime

Gram (+) and Gram (-)

40
Q

5th gen cephalosporins + coverage

A

Ceftaroline

Gram (+) and Gram (-)

41
Q

What is noteworthy about Ceftriaxones elimination compared to the other cephalosporins?

A

It is not eliminated by kidney, so no dose adjustment if renal issues

42
Q

Which four cephalosporins cause bleeding issues?

A

Cefmetazole, cefoperazone, cefotetan, ceftriaxone

43
Q

What are the parenteral cephalosporins?

A

Ceftriaxone (3rd)

Cefepime (4th)

44
Q

What are the oral cephalosporins?

A

Cefditoren and Cefpodoxime (3rd)

45
Q

Which antibiotics are great for bacteria without a cell wall?

A

Tetracyclines

-mycoplasma pneumonia

46
Q

What is an issue with prescribing tetracyclines in kids?

A

Deposits into teeth and bones, causing gray discoloration

47
Q

What can impair absorption of tetracyclines?

A

Dicationic metals

-Mg, Ca, Al, Fe

48
Q

What antibiotics are great for atypical pneumonia (legionella, mycoplasma, chlamydia)?

A

Macrolides

-azithromycin or clarithromycin

49
Q

Which macrolide does NOT inhibit CYP450?

A

Azithromycin

Erythro and Clarithro do!

50
Q

Which macrolide causes pretty bad GI pain?

A

Erythromycin

51
Q

Which macrolide can be given as a single dose, slow release?

A

Azithromycin

52
Q

What drugs are the respiratory floroquinolones?

A

Levofloxacin, Gemifloxacin, and Moxifloxacin

Broad spectrum, reserved last resort

53
Q

What toxicity is important for fluoroquinolones?

A

Achille’s tendon rupture

54
Q

Which drug is great for MRSA and MRSE, but can cause Red-man syndrome?

A

Vancomycin

55
Q

MOA and coverage of Linezolid

A

binds 23s RNA of 50S subunit

Gram (+)-Great for VRE

56
Q

Adverse effects of linezolid?

A

Blocks monoamine oxidase, so can have increase in serotonin (serotonin syndrome)

Lactic acidosis, thrombocytopenia, peripheral neuropathy, hypoglycemia in diabetics

57
Q

MOA and Coverage of Aztreonam

A

Penicillin-Binding-Protein (PBP) that blocks bacterial cell wall synthesis

Gram (-)

58
Q

MOA and Coverage of Imipenem

A

Penicillin-Binding-Protein (PBP) that blocks bacterial cell wall synthesis

Broad spectrum
-last resort!

59
Q

Adverse effects of imipenem?

A

CNS effects: seizures, confusion

60
Q

MOA and coverage of gentamicin

A

bind irreversibly to the 30S ribosomal subunit, inhibiting formation of initiation complex

Mostly Gram (-), but also staph (+)

61
Q

Adverse effects of gentamicin?

A

Nephrotoxicity, Neurotoxicity, Ototoxicity

62
Q

What are the hard to kill bugs? ESKAP(e)

A 
Enterobacter
S. aureus
Klebsiella
A. baumannii
P. aeruginosa

Have post-translational modifications that provide resistance

Pharmacology (50 decks)

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