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Pharmacology (Dale Turley) > Respiratory (Pneumonia) - Exam 4 > Flashcards

Respiratory (Pneumonia) - Exam 4 Flashcards

1
Q

CAP defined as?

A

an acute infection of the pulm. parenchyma in a patient who has acquired the infection in the community

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2
Q

HCAP definition?

A

healthcare-associated PNA - is acquired in other healthcare facilities, such as nursing homes, dialysis centers, and outpatient clinics

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3
Q

The rationale for the separate designation of HCAP was that patients with HCAP were at higher risk for ___________________ organisms

A

multidrug resistant (MDR)

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4
Q

CAP is a common and serious illness and is associated with morbidity and mortality, especially in _____ & patients with _______________.

A

older

comorbidities

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5
Q

Determining whether a patient should be admitted or treated as an outpatient is essential before what? And what is the determining factor in making this decision?

A

it is essential before selecting an ABS regimen

Severity of illness is the most critical factor in making this determination

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6
Q

CURB-65 helps with the decision of the site of care for CAP and uses what 5 prognostic variables?

A 
Confusion
Urea - BUN - > 7 mmol/L
Resp. rate - > 30 
BP - <90/60
Age - > 65
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7
Q

_______ (___) is primarily ordered to help determine if someone has lactic acidosis, a level of lactate that is high enough to disrupt a patients pH balance, and is a great predictor of sepsis and degree of illness.

A

Lactate (LDH)

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8
Q

CAP is most commonly caused by what bacteria?

A

Streptococcus pneumoniae

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9
Q

What is the Gold Standard for diagnosing pneumonia (CAP) when clinical features are supportive?

A

the presence of an infiltrate on plain chest radiograph

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10
Q

Other frequent isolated pathogens for CAP are ?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
respiratory viruses (parainfluenza, influenza, RSV)

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11
Q

Less common isolated CAP pathogens?

A

Legionella

H. Flu

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12
Q

What pathogens make patients typically sicker and require admission to the hospital - CAP?

A

Staph
Enterobacteriaceae
Pseudomonas

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13
Q

CAP primary treatments?

A 
Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Erythromycin (E-mycin)
Levofloxacin (Levaquin)
Doxycycline (Vibramycin)
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14
Q

Macrolides MOA?

A

inhibit synthesis at 50 S ribosomal unit

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15
Q

Macrolide clinical uses?

A

CAP believed to be caused by penicillin-sensitive STREP or H. Flu or any atypical pathogen

can be bactericidal or bacteriostatic depending on the susceptibility and conc.

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16
Q

Proceed with caution in using macrolides in?

A 
elderly
hepatic impairment
renal impairment
QT prolongation
torsades de pintes hx
MI
CHF
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17
Q

MOA of Levofloxacin (Levaquin) Fluroquinolones?

A

inhibit microbial nucleic acid metabolism

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18
Q

what ABS does resistance vary geographically?

A

Levofloxacin

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19
Q

Levofloxacin (Levaquin) BBW?

A

disabling, potentially irreversible serious reactions

tendinitis/tendon rupture

Prolonged QT syndromes

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20
Q

Doxycycline (Vibramycin) MOA?

A

Bacteriostatic; binds to 30S and possibly 50S ribosomal subunits, inhibiting protein synthesis

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21
Q

Doxycycline class?

A

tetracyclines

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22
Q

Serious reactions with Doxycycline (Vibramycin)

A

photosensitivity
superinfection
C.Diff associated diarrhea

avoid use during pregnancy and lactation

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23
Q

AKA walking pneumonia?

A

Atypical Pneumonia

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24
Q

Are there any distinguishing clinical or radiological manifestations between CAP typical and atypical ?

A

NO

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25
Q

The mainstay of therapy for possible M. pneumoniae infection are?

A

marcolides (zithromax) or a fluroquinolones

26
Q

Erythromycin MOA?

A

binds to 50S ribosomal subunit, inhibiting protein synthesis

bacteriostatic or bactericidal; depending on susceptibility and concentration

27
Q

Erythromycin side effects?

A

diarrhea, nausea, vomitting, red rash, increased risk of sun burn

permanent problems with young children including changing the color of their teeth

28
Q

HCAP common organisms?

A 
Staph
MRSA
Candida albicans
Pseudomonas
Acinetobacter
Stenotrophomonas
C.diff
E.coli
TB
VRE
Legionnaires
29
Q

HAP or HCAP tx? general

A 
Ceftriaxone (Rocephin)
Cefepime
Piperacillin/tazobactam
Ertapenem
Meropenem
Levofloxacin
Vanco
30
Q

Ceftriaxone (Rocephin) - Cephalosporins MOA?

A

Cephalosporins bind to PBP’s on bacterial cell membranes to inhibit bacterial cell wall synthesis by mechanisms similar to those of the penicillin’s

bactericidal

31
Q

2nd Generation Cephalosporin is slightly less active against G+ organisms than the 1st gene but it has an __________________?

A

extended G- coverage

32
Q

what are some G- bacteria?

A

Salmonella
Shigella
E.Coli
H.Pylori

33
Q

Clinical uses of 2nd gen. cephalosporins?

A

infections caused by the anaerobe Bacteroides fragilis (cefoxitin)

34
Q

Clinical uses of 4th gen. cephalosporins and examples?

A

Combines the G+ activity of first-generation agents with the wider G- spectrum of 3rd gen ceph.

Cefepime - more resistant to beta-lactamases produced by G- organisms

35
Q

Example of 4th gen cephalosporin?

A

cefepime

36
Q

Caution in patients with what when prescribing Cephalosporins?

A

penicillin allergies

37
Q

Cephalosporins MOA?

A

interferes with synthesis of the bacterial cell wall and thus are bactericidal

38
Q

MOA of Piperacillin/tazobactum sodium (Zosyn)?

A

Pipercillin inhibits bacterial cell wall synthesis by binding to one or more of the PBP’s - more broad spectrum more coverage

Tazobactam inhibits many beta-lactamases

39
Q

Class and MOA of Ertapenem (Invanc) and Meropenem (Merrem)?

A

Class: Carbapenem’s

MOA: like beta lactase, binds to PBP’s and inhibits cell wall synthesis

Broader spectrum of activity the cephalosporins and PCN’s

40
Q

MOA of Fluroquinolones?

A

inhibit microbial nucleic acid metabolism

41
Q

When is Vanco used?

A

serious infections caused by drug-resistant G+ organisms, including MRSA

42
Q

Class of Vanco?

A

Glycopeptide

43
Q

MOA of vanco?

A

inhibit cell wall synthesis in G+ bacteria

44
Q

Which organisms does vanco not work against?

A

G- organsims (E.coli, pseudomonas)

45
Q

Monitor vanco by ___________ to determine correct dosage

A

blood level (peak and trough)

46
Q

Treatment for severe C. diff colitis?

A

Oral Vancomycin

47
Q

Common side effects include pain in the area of injection and allergic reactions like ______________.

A

red man syndrome

may have problems with hearing, low BP and bone marrow suppression

48
Q

Trimethoprim + sulfamethoxazole (Bactrim) MOA ?

A

Trimethoprim- inhibitor of dihydrofolate reductase

sulfamethoxazole - inhibit microbial enzymes involved in folic acid synthesis

49
Q

Sulfonamides and trimethoprim are ________________.

A

antimetabolites

and are selectively toxic to microorganisms because they interfere with folic acid synthesis

50
Q

The combination of a sulfonamide with trimethoprim causes a sequential blockade of __________ synthesis.

A

folic acid

51
Q

Patient education for sulfonamides?

A

notify clinician if see skin rash
no driving
drink liberal amount of fluids to prevent crystalluria

52
Q

Conscientious Considerations of Sulfonamides?

A

watch for SJS

watch for G6PD deficiency as can lead to anemia

Hypersensitivities can occur up to 12 days AFTER exposure

53
Q

Examples of Respiratory antivirals ?

A

Oseltamivir (Tamiflu) - primary

Amantadine ( Symmetrel) - fallen by the way side

54
Q

Oseltamivir (Tamiflu) class and used to treat what?

A

Class: antiviral medication

and used to treat influenza A & B and to prevent flu after exposure (Hospitalized immunocompromised patients and pregnancy)

55
Q

Oseltamivir MOA?

A

it is a prodrug and it is hydrolyzed to the active form, oseltamivir carboxylate (OC)

56
Q

Oseltamivir is hydrolyzed into active for ________________.

A

Oseltamivir carboxylate (OC)

57
Q

OC inhibits influenza virus _____________.

A

neurominidase

58
Q

Amantadine (Symmetrel) class?

A

antiviral agent
anti-parkinson agent,
dopamine agonist

59
Q

Amantadine is used to treat __________?

A

influenza A

60
Q

why is Amantadine no longer recommended for the treatment or prophylaxis of influenza A?

A

Issues of resistance

Pharmacology (Dale Turley) (31 decks)

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