Respiratory Flashcards
- What is the MOA of penicillins?
- In what group of patients is a dose reduction required?
- Name 5 examples
- BETA LACTAM - inhibition of enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
- renal impairment
3. amoxicillin
benzylpenicillin
co-amoxiclav
flucloxicillin
pipericillin-tazobactam
- What is the MOA of cephalosporins?
- In which group of patients is a dose reduction required?
- in which group of patients should these drugs be avoided?
- name 4 examples
- BETA LACTAM - inhibition of enzymes responsible for cross-linking peptidoglycans in bacterial cell walls
- renal impairment
- penicillin allergy (due to risk of cross-reactivity)
- cefaclor
cefuroxime
cefotaxime
ceftriaxone
- What is the MOA of macrolides?
- In which group of patients is a dose reduction often required?
- Name 3 examples
- inhibit 50s ribosome subunit, thus inhibit bacterial protein synthesis
- renal and hepatic impairment
- erythromycin
clarythromycin
azithromycin
- What is the MOA of aminoglycosides?
- Name 2 serious complications of aminoglycosides
- Name 3 examples
- inhibit 30s ribosome subunit therefore inhibits bacterial protein synthesis
- nephrotoxicity
ototoxicity - gentamycin
streptomycin
tobramycin
- what is the MOA of tetracycilnes?
- In which group of patients should tetracyclines be avoided (and why?)
- Name another drug which tetracyclines cross react with
- Name 4 examples
- inhibition of 30s ribosomal subunit thus inhibit bacterial protein synthesis
- children and pregnant/breastfeeding women - discolours teeth and bones
- warfarin (enhances anticoagulant effect)
- doxycycline
tetracycline
minocycline
lymecycline
- What is the MOA of quinolones
2. Name 2 examples
- inhibits bacterial DNA synthesis
- ciprofloxacin
mocifloxacin
What are the components of the CURB-65 score?
C - confusion U - urea (raised) R - RR > 30 B - systolic BP <90 65 - aged >65
What are the implications of CURB-65 score for level of care
- 0-1
- 2
- 3
- 4-5
- low risk of death; suitable for treatment at home
- moderate risk of death; short stay hospital treatment or hospital-supervised outpatient care
- higher risk of death; managed as inpatient
- high risk of death; may require critical care intervention
Name 4 causative organisms of typical pneumonia
- Strep pneumoniae
- H influenzae
- group A strep
- staph aureus
What antibiotics are prescribed first and second line to patients who are able to take penicillin with the following CURB-65 scores:
- 0-1
- 2
- 3-5
- amoxicillin 500mg every 8 hours
- oral doxycycline 100mg 12 hourly
oral amoxicillin + clarythromycin - IV co-amoxiclav 1.2g 8hrly + IV clarythromycin 500mg 1-2 hrly
What antibiotics are prescribed first and second line to patients who are allergic penicillin with the following CURB-65 scores:
- 0-1
- 2
- 3-5
- oral doxycycline 100mg 12 hrly
- oral doxycycline 100mg 12hrly
oral clarythromycin 500mg 8hrly - IV cefotaxime 1g 8hrly + IV clarythromycin 500mg 12hrly
In terms of antimicrobial stewardhsip, which type of antibiotics, and which route of administration are preferred?
oral, narrow spectrum antibiotics
Name 4 aetiological organisms of Atypical pneumonia
- legionella
- mycoplasma pneumoniae
- chlamydiphilla pneumoniae
- c burnettii
- How is atypical pneumonia caused by legionella treated?
2. How is atypical pneumonia caused by other organisms treated?
- fluroquinolone
2. macrolides
Name 4 drugs used to treat tuberculosis
- rifampicin
- isoniazid
- pyrazinamide
- ethambutol
- Which TB drug is a CYP450 inducer?
- Which TB drug is associated with hepatotoxicity and gout
- Which TB drug is associated with optic neuritis
- which TB drug discolours bodily secretions orange?
- which TB drug can cause hepatotoxicity and peripheral neuropathy?
- rifampicin
- pyrazinamide
- ethambutol
- rifampicin
- isoniazid
- What is the treatment regime for latent TB?
2. What is the treatment regime for active TB?
- 6 months of isoniazid or 3 months of rifampicin + isoniazid
- intensive phase - 2 months of 4 drugs
continuation phase - 4-7 months of 2 drugs
When treating acutely ill patients with signs and symptoms of infective endocarditis, when is empirical antibiotic therapy started?
after at least 3 (preferably 3) sets of blood cultures have been obtained from separate venopunctures
What is complete control of asthma defined as? (6)
- no daytime symptoms
- no night time awakening due to asthma
- no asthma attacks; no need for rescue medication
- no limitations on activity, including exercise
- normal lung function (FEV1 and/or peak flow)
- minimal side effects from treatment
What are the BTS asthma management guidelines?
- PRN SABA
- add low dose ICS
- add LABA
- increase ICS or add leukotriene receptor antagonist/theophylline
- add oral steroid
- Name 2 examples of SABAs
2. name 6 side effects from the use of SABAs
- salbutamol
terbutaline
2. tachycardia
tremor
hypotension
hyperkalaemia
hyperglycaemia
angioedema
name 2 examples of inhaled corticosteroids
- beclometasone
- fluticasone
- name 2 examples of LABAs
2. which LABA is suitable for concomittant use with ICS and why?
- salmeterol; formeterol
2. formeterol (due to fast onset of action)
- What is the MOA of theophylline?
- Name an example that is commonly used
- name complications of this?
- why are there lots of drug interractions?
- inhibits phosphodiesterase, and blocks adenosine receptors, leading to bronchodilation and a reduced inflammatory response
- aminophylline
- cardiac arrythmias, GI disturbance, seizures
- metabolised by CPY450
What is the MOA of montelukast?
leukotriene receptor antagonists
How is status asthmaticus managed?
- oxygen (via non-rebreathe mask)
- nebulised SABA
- oral pred/IV hydrocortisone
- nebulised ipratropium
- IV Mg (acts as a bronchodilator)
- ICU admission if sats <90%
What is the stepwise management of COPD?
- SABA or SAMA
- LABA + LAMA or LABA + ICS
- LABA + LAMA + ICS
- What is the MOA of muscarinic receptor antagonists in the treatment of COPD?
- Name 2 examples
- promotes bronchodilation
- ipratropium
tiotropium
When is oxygen therapy indicated?
In hypoxaemia, to achieve target sats of 94-98%
- How should nebulisers be driven in patients with asthma?
2. How should nebulisers be driven in patients with hypercapnic acidosis?
- driven by piped oxugen
2. driven by compressed air (if necessary, to maintain O2 sats, supplimentary O2 should be delivered via nasal cannulae)
- What does a non-rebreathe O2 mask deliver?
2. What are the indications for this mask?
- variable O2 concentrations (depending on patient’s respiratory effort) between 60 and 80%
- critical illness, trauma patients, post arrest
- What are the indications of a simple face mask?
- In which patients should they be avoided?
- why should O2 flow be at least 5L/min?
- type I respiratory failure
- patients with a hx or at risk of hypercapnic respiratory failure
- to prevent CO2 build up
- What are the indications of a venturi mask?
2. What type of oxygen does it deliver?
- patients requiring controlled/low dose oxygen or patients at risk of type II respiratory failure
- constant oxygen concentration at different flow rates
