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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
Q

Antibiotic tx of AECB: simple chronic bronchitis

A 
Macrolide (azithromycin, clarithromycin)
OR 
2nd or 3rd generation cephalosporin (cefuroxime, cefpodoxime, cefdinir)
OR
Doxycycline
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26
Q

Antibiotic tx of AECB: Complicated chronic bronchitis + comorbities

A

Respiratory fluoroquinolone (moxifloxacin, gemifloxacin, levofloxacin)
OR
Amoxicillin/clavulanate
OR
2nd or 3rd generation cephalosporin + doxycycline

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27
Q

Antibiotic tx of AECB: If at risk for pseudomonas

A

Levofloxacin

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28
Q

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?

A

Simple chronic bronchitis,

Macrolides or 2nd/3rd gen cephalosporin or doxycycline

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29
Q

Antigenic drift

A

Relatively minor change in genetic material
Enough change to require new vaccine every year
Generally short influenza season

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30
Q

Antigenic shift

A

Major change in genetic material
May lead to pandemic and high mortality
Generally prolonged or multi-wave influenza season

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31
Q

Community acquired UTIs

A
  • Typically gram-negative enterobacteriaceae
  • E. coli
  • Klebsiella
  • Proteus spp.
  • Staphylococcus saprophytic
32
Q

Urinalysis

A
  • Turbidity
  • Odor
  • Specific Gravity
  • pH
  • Nitrites
  • Leukocyte esterase
33
Q

What pH is associated with UTI

A

Alkaline urine

34
Q

Urine microscopy

A
  • WBCs (clumping, presence of pus)
  • Epithelial cells (many squamous cells)
  • WBC casts (Acute pyelonephritis)
  • Bacteria
35
Q

Uncomplicated Cystitis First line tx

A
  • Nitrofurantoin monohydrate/macrocrystals (Macrobid®)
  • Trimethoprim-sulfamethoxazole
  • Fosfomycin trometamol
36
Q

Uncomplicated Cystitis second line tx

A

β-lactam antibiotics

Fluoroquinolones

37
Q

MOA:
Nitrofurantoin is reduced by bacterial flavoproteins to reactive intermediates which inactivate or alter bacterial ribosomal proteins and other macromolecules

A

Macrobid

38
Q

Macrobid AE

A

GI: loss of appetite, N/V

Headache

39
Q

Macrobid contraindications

A

Poor renal function, anuria, oliguria
Pregnant pt’s at 38-42 wks
-Avoid if pyelonephritis is suspected

40
Q

Bactrim AE

A
  • 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
Q

Bactrim contraindications

A
  • Pregnancy category C

- Sulfa allergies

42
Q

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

A

Fosfomycin trometamol

43
Q

Fosfomycin trometamol AE:

A

Diarrhea
Nausea/vomiting
Skin rash

44
Q

Fosfomycin trometamol contraindications

A
  • 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
Q

Beta lactam antibiotics most commonly used for UTI

A
  • Cephalexin (Keflex)
  • Amoxicillin-clavulanate
  • Cefpodoxime

-Amoxicillin and ampicillin should not be used!

46
Q

Uncomplicated Pyelonephritis: Outpatient Treatment

A

-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
Q

Uncomplicated Pyelonephritis: Inpatient Treatment

A

-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
Q

Complicated Pyelonephritis: Community acquired Treatment

A

IV cephalosporin (Ceftriaxone)

49
Q

Complicated Pyelonephritis: Critically ill, septic, healthcare acquired Treatment

A

Anti-pseudomonal B-lactam: Zosyn

50
Q

What is first choice treatment for VRE UTIs?

A

Ampicillin

51
Q

UTI suppressive therapy/prophylaxis

A

Nitrofurantoin
Bactrim
Cephalexin

52
Q

Impetigo tx

A

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
Q

Abscess, Furuncles, and Carbuncles tx

A

-Antibiotics not always necessary
-Bactrim
-Doxycycline or minocycline
-Clindamycin
Alternative- linezolid.

54
Q

Non-purulent cellulitis oral tx

A

First line oral:

  • Cephalexin
  • Bactrim

Second line:

  • Clindamycin
  • Linezolid
  • Doxycycline or minocycline
55
Q

Non-purulent cellulitis- IV tx

A
  • Cefazolin
  • Clindamycin
  • Vanco
  • Avoid bactrim!! high resistance to Group A strep
56
Q

Purulent Cellulitis oral therapy

A
  • Bactrim
  • Clindamycin
  • Doxcycline or minocycline
  • Linezolid
57
Q

Purulent cellulitis IV therapy

A
  • Vanco
  • Daptomycin
  • Linezolid
58
Q

Necrotizing fasciitis IV tx

A
  • Zosyn + vanco
  • Cefepime + vanco
  • Aztreonam + Vanco
59
Q

Most causative organisms of diabetic foot infections

A

Staph and Strep

60
Q

Appendicitis common pathogens

A
  • Enteric gram negatives
  • E.coli
  • Klebsiella
  • Proteus
  • Anaerobes (Bacteroides)
61
Q

Appendicitis tx

A

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
Q

Cholangitis common pathogens

A

E. coli, Klebsiella, Bacteroides

63
Q

Cholangitis/Cholesystitis tx

A

Same as appendicitis ex no monofloxacin

64
Q

Diverticulitis common pathogens

A

E. coli, klebsiella, bacteroides
-Pt’s with frequent recurring infection with extension antibiotic exposure may be infected with: enterobacter, pseudomonas, enterococcus

65
Q

Diverticulitis management: oral antibiotics

A
  • Amoxicillin/clavulanate
  • Ciprofloxacin plus metronidazole
  • Trimethoprim/sulfamethoxazole plus metronidazole
66
Q

Diverticulitis management: IV antibiotics

A

BL/BLI:
-Ampicillin/sulbactam, Piperacillin/tazobactam

IV Cephalosporin plus metronidazole
(Cefazolin, Cefuroxime or Ceftriaxone) plus metronidazole

  • Ciprofloxacin plus metronidazole
  • Aztreonam plus metronidazole
67
Q

Appendicitis, Cholangitis, Cholesystitis duration of therapy:

A

4 days, unless not well controlled then till resolution of infection (2-4+ weeks

68
Q

Diverticulitis duration of therapy:

A

Usually 7 days

69
Q

Spontaneous bacterial peritonitis pathogens

A

-E. coli, strep, klebsiella

70
Q

Secondary peritonitis pathogens

A

Usually polymicrobial: Enteric GNRs and bactericides

71
Q

Peritonitis first line tx

A

Ceftriaxone

72
Q

Peritonitis 2nd line tx

A

Levofloxacin (higher rates of E. coli resistance

73
Q

Secondary peritonitis antibiotics:

A

Polymicrobial
BL/BLI:
-Ampicillin/sulbactam, Piperacillin/tazobactam
-IV Cephalosporin plus metronidazole
(Cefazolin, Cefuroxime or –Ceftriaxone) plus metronidazole
-Ciprofloxacin plus metronidazole
-Aztreonam plus metronidazole

74
Q

Tertiary Peritonitis tx

A
  • Piperacillin/tazobactam plus vancomyicn
  • Cefepime plus metronidazole, plus vancomycin
  • Aztreonam plus metronidazole plus vancomycin
75
Q

Pancreatitis tx:

A
  • Piperacillin/tazobactam
  • Cefepime plus metronidazole
  • Imipenem or meropenem

Pharm exam 3 (2 decks)

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