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Pharm exam 3 > Respiratory Infections > Flashcards

Respiratory Infections Flashcards

1
Q

Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis

A

Typical bacteria

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2
Q

Mycoplasma pneumoniae

Chlamydophila pneumoniae

A

Atypical bacteria

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3
Q

Influenza, adenovirus, RSV, parainfluenza

A

Respiratory viruses

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4
Q

Typical bacteria presentaion

A

-High fever, productive cough, consolidated infiltrates, rapid onset

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5
Q

Atypical bacteria presentation

A

Mild fever, non-productive cough, diffuse or patchy infiltrates, slower onset

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6
Q

If use of antimicrobials within the previous 3 months………

A

AVOID same class antibiotics!!

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7
Q

Risk Factors for Drug Resistant

S. pneumoniae (DRSP)

A 
Age >65 years
β-lactam, macrolide, or fluoroquinolone therapy within the past 3 months
Alcoholism
Multiple medical comorbidities
Immunosuppressive illness or therapy
Exposure to a child in a day care
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8
Q

Previously healthy, no use of antimicrobials within past 3 months, outpatient CAP tx

A

Macrolide (azithromycin, clarithromycin)
OR
Doxycycline

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9
Q

Presence of comorbidities or previous antimicrobial use within past 3 months or risk factors for DRSP outpatient tx

A

Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin)
OR
[Amoxicillin/clavulanate or cephalosporin] + macrolide
OR
[Amoxicillin/clavulanate or cephalosporin] + doxycycline

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10
Q 
If Pseudomonas is suspected (based on comorbidities):
COPD
Structural lung disease
Smoking
outpatient tx
A

Levofloxacin (750 mg daily, high dose)
OR
Consider IV antipseudomonal β-lactam

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11
Q

Outpatient CAP if hx of alcoholism

A 
Amoxicillin/clavulanate
OR
Cephalosporin + clindamycin
OR
Respiratory fluoroquinolone
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12
Q

Outpatient CAP if aspiration suspected

A 
Amoxicillin/clavulanate 
OR
Moxifloxacin
OR
Clindamycin
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13
Q

Drugs for pseudomonas coverage

A

Cefepime, zosyn, carbapenems

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14
Q

Drugs for MRSA coverage

A

Vancomycin or linezolid

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15
Q

HAP empiric tx

A

Should always cover MRSA & P. Aeruginosa & GNRs

-Pseudomonas & MRSA coverage

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16
Q

HAP empiric tx if prior IV abx use in last 90 days or high risk for mortality

A
  • 2 anti-pseudomonal agents
  • Cefepmie & tobramycin
  • Pip/taxo & levofloxacin
  • Do not use 2 beta lactams!!!
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17
Q

VAP organisms

A
  • Staphylococcus aureus (20-30% of isolates)
  • Pseudomonas aeruginosa (10-20% of isolates)
  • Acinetobacter baumannii (5-10% of isolates) - very high resistance rates!!
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18
Q

Duration of therapy

A

8-15 days

Higher % of multidrbg-resistance seen with longer tx duration

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19
Q

Whooping cough
Persistent cough >14 days
Uncommon occurrence
High probability of exposure during outbreak
R/O asthma, GERD, Post-nasal drip
Antibiotic therapy aimed at eradicating nasal carriage

A

Bordetella pertussis

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20
Q

Bordetelle pertussis children tx

A
  • Erythromycin estolate PO
  • Erythromycin base PO
  • Azithromycin
  • Clarithromycin
  • Isolate pt 5 days from start of tx!
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21
Q

Bordetella pertussis adult tx

A
  • Azithromycin
  • Erythromycin estolate
  • Bactrim (TMP/SMX)
  • Clarithromycin
  • Isolate pt 5 days from start of tx!
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22
Q

Most common typical bacteria

A

H. Influenzae

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23
Q

Common viral pathogens

A
  • Rhinovirus
  • Influenza A & B
  • Parainfluenza
  • Coronavirus
  • Respiratory syncytial virus (RSV)
  • Adenovirus
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24
Q

Treatment of AECB

A

ABC approach

  • Antibiotics
  • Bronchodilators
  • Corticosteroids
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25
Antibiotic tx of AECB: simple chronic bronchitis
``` Macrolide (azithromycin, clarithromycin) OR 2nd or 3rd generation cephalosporin (cefuroxime, cefpodoxime, cefdinir) OR Doxycycline ```
26
Antibiotic tx of AECB: Complicated chronic bronchitis + comorbities
Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin) OR Amoxicillin/clavulanate OR 2nd or 3rd generation cephalosporin + doxycycline
27
Antibiotic tx of AECB: If at risk for pseudomonas
Levofloxacin
28
BM is a 47 year old male who has been diagnosed with chronic bronchitis. He reports having 3 exacerbations per year. He comes to your clinic with signs and symptoms consistent with an acute exacerbation. What type of chronic bronchitis does this patient have? What antibiotics would you prescribe?
Simple chronic bronchitis, | Macrolides or 2nd/3rd gen cephalosporin or doxycycline
29
Antigenic drift
Relatively minor change in genetic material Enough change to require new vaccine every year Generally short influenza season
30
Antigenic shift
Major change in genetic material May lead to pandemic and high mortality Generally prolonged or multi-wave influenza season
31
Community acquired UTIs
- Typically gram-negative enterobacteriaceae - E. coli - Klebsiella - Proteus spp. - Staphylococcus saprophytic
32
Urinalysis
- Turbidity - Odor - Specific Gravity - pH - Nitrites - Leukocyte esterase
33
What pH is associated with UTI
Alkaline urine
34
Urine microscopy
- WBCs (clumping, presence of pus) - Epithelial cells (many squamous cells) - WBC casts (Acute pyelonephritis) - Bacteria
35
Uncomplicated Cystitis First line tx
- Nitrofurantoin monohydrate/macrocrystals (Macrobid®) - Trimethoprim-sulfamethoxazole - Fosfomycin trometamol
36
Uncomplicated Cystitis second line tx
β-lactam antibiotics | Fluoroquinolones
37
MOA: Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates which inactivate or alter bacterial ribosomal proteins and other macromolecules
Macrobid
38
Macrobid AE
GI: loss of appetite, N/V | Headache
39
Macrobid contraindications
Poor renal function, anuria, oliguria Pregnant pt's at 38-42 wks -Avoid if pyelonephritis is suspected
40
Bactrim AE
- Rash > Can be severe (Stevens-Johnson syndrome, toxic epidermal necrolysis) - Loss of appetite, nausea/vomiting - Bone marrow suppression: neutropenia, thrombocytopenia - Increases in serum creatinine
41
Bactrim contraindications
- Pregnancy category C | - Sulfa allergies
42
MOA: Inactivates the enzyme pyruvyl transferase, which is responsible for transformation of N-acetylglucosamine into N-acetyl-muraminic acid; which is required for synthesis of the cell wall peptidoglycan
Fosfomycin trometamol
43
Fosfomycin trometamol AE:
Diarrhea Nausea/vomiting Skin rash
44
Fosfomycin trometamol contraindications
- Avoid if pyelonephritis is suspected! (Only absorbed into the GU tract) - Pregnancy Category B - More expensive than other first line options for uncomplicated cystitis - Commonly has activity against resistant E. coli and Enterococcus
45
Beta lactam antibiotics most commonly used for UTI
- Cephalexin (Keflex) - Amoxicillin-clavulanate - Cefpodoxime -Amoxicillin and ampicillin should not be used!
46
Uncomplicated Pyelonephritis: Outpatient Treatment
-Fluoroquinolones Ciprofloxacin 500 mg BID x 7 days (+/- one IV dose) Levofloxacin 750 mg QD x 5 days -Trimethoprim-sulfamethoxazole (Bactrim®) 160/800 mg tablet BID x 14 days *Should only be used as step-down therapy if organism is known to be susceptible
47
Uncomplicated Pyelonephritis: Inpatient Treatment
-β-lactam antibiotics: Typically IV Examples: Ceftriaxone 1g IV daily x 14 days Can also transition to options above following 1 dose of IV therapy with a β-lactam such as ceftriaxone (1g x 1) or an aminoglycoside such as gentamicin (2 mg/kg x 1)
48
Complicated Pyelonephritis: Community acquired Treatment
IV cephalosporin (Ceftriaxone)
49
Complicated Pyelonephritis: Critically ill, septic, healthcare acquired Treatment
Anti-pseudomonal B-lactam: Zosyn
50
What is first choice treatment for VRE UTIs?
Ampicillin
51
UTI suppressive therapy/prophylaxis
Nitrofurantoin Bactrim Cephalexin
52
Impetigo tx
Topical therapy is 1st line therapy: Mupriocin 2% Oral tx if involvement in the eye, extensive or disseminated disease: Dicloxacillin or cephalexin 2nd- clinadmycin or bactrim
53
Abscess, Furuncles, and Carbuncles tx
-Antibiotics not always necessary -Bactrim -Doxycycline or minocycline -Clindamycin Alternative- linezolid.
54
Non-purulent cellulitis oral tx
First line oral: - Cephalexin - Bactrim Second line: - Clindamycin - Linezolid - Doxycycline or minocycline
55
Non-purulent cellulitis- IV tx
- Cefazolin - Clindamycin - Vanco - Avoid bactrim!! high resistance to Group A strep
56
Purulent Cellulitis oral therapy
- Bactrim - Clindamycin - Doxcycline or minocycline - Linezolid
57
Purulent cellulitis IV therapy
- Vanco - Daptomycin - Linezolid
58
Necrotizing fasciitis IV tx
- Zosyn + vanco - Cefepime + vanco - Aztreonam + Vanco
59
Most causative organisms of diabetic foot infections
Staph and Strep
60
Appendicitis common pathogens
- Enteric gram negatives - E.coli - Klebsiella - Proteus - Anaerobes (Bacteroides)
61
Appendicitis tx
BL/BLI: - Ampicillin/sulbactam, Piperacillin/tazobactam - Oral step-down to amoxicillin/clavulanate IV Cephalosporin plus metronidazole - Cefazolin plus metronidazole - Cefuroxime plus metronidazole - Ceftriaxone plus metronidazole - Ciprofloxacin, levofloxacin or moxifloxacin) plus metronidazole - Aztreonam plus metronidazole
62
Cholangitis common pathogens
E. coli, Klebsiella, Bacteroides
63
Cholangitis/Cholesystitis tx
Same as appendicitis ex no monofloxacin
64
Diverticulitis common pathogens
E. coli, klebsiella, bacteroides -Pt's with frequent recurring infection with extension antibiotic exposure may be infected with: enterobacter, pseudomonas, enterococcus
65
Diverticulitis management: oral antibiotics
- Amoxicillin/clavulanate - Ciprofloxacin plus metronidazole - Trimethoprim/sulfamethoxazole plus metronidazole
66
Diverticulitis management: IV antibiotics
BL/BLI: -Ampicillin/sulbactam, Piperacillin/tazobactam IV Cephalosporin plus metronidazole (Cefazolin, Cefuroxime or Ceftriaxone) plus metronidazole - Ciprofloxacin plus metronidazole - Aztreonam plus metronidazole
67
Appendicitis, Cholangitis, Cholesystitis duration of therapy:
4 days, unless not well controlled then till resolution of infection (2-4+ weeks
68
Diverticulitis duration of therapy:
Usually 7 days
69
Spontaneous bacterial peritonitis pathogens
-E. coli, strep, klebsiella
70
Secondary peritonitis pathogens
Usually polymicrobial: Enteric GNRs and bactericides
71
Peritonitis first line tx
Ceftriaxone
72
Peritonitis 2nd line tx
Levofloxacin (higher rates of E. coli resistance
73
Secondary peritonitis antibiotics:
Polymicrobial BL/BLI: -Ampicillin/sulbactam, Piperacillin/tazobactam -IV Cephalosporin plus metronidazole (Cefazolin, Cefuroxime or --Ceftriaxone) plus metronidazole -Ciprofloxacin plus metronidazole -Aztreonam plus metronidazole
74
Tertiary Peritonitis tx
- Piperacillin/tazobactam plus vancomyicn - Cefepime plus metronidazole, plus vancomycin - Aztreonam plus metronidazole plus vancomycin
75
Pancreatitis tx:
- Piperacillin/tazobactam - Cefepime plus metronidazole - Imipenem or meropenem

Pharm exam 3 (2 decks)

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