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Pulmonology > Sweatman Bacterial Infections of the Lungs > Flashcards

Sweatman Bacterial Infections of the Lungs Flashcards

1
Q

what constitutes lower respiratory region

A

respiratory bronchioles, alveolar ducts, alveoli

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2
Q

symptoms of pneumonia

A 
fever
cough with our without sputum
dyspnea
chest pain
infiltrates on radiograph (diagnostic)
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3
Q

unproducitve cough=

A

viral or mycoplasma

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4
Q

most important factor is successful tx. of pneumonia

A 
early intervention
(mortality decreases when you wait even 8 hours)
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5
Q

4 types of pneumonia

A

CAP
nocosomial
aspiration
immunocompromosed host

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6
Q

define nocosomial/hospital acquired

A

appears within 48 hours of arrival/admission without evidence of existing prior to arrival

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7
Q

most common agent 0-6 weeks for CAP

A

group B strep

E coli

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8
Q

most common agents 6 weeks-18 yrs for CAP

A

viruses (flu, RSV, rino, parflu, adeno)
Myco pneumonia
chlamydia pneumonia
Strep pneumonia

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9
Q

most common 18-40 yrs for CAP

A

Mycoplasma pneumonia

strep pneumonia

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10
Q

most common 40-65 cor CAP

A 
Strep pneumonia
H flu
anaerobes (bacteroides, fusobacterium)
viruses
mycoplasma pneumonia
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11
Q

most common >65 yrs for CAP

A 
Strep pneumonia
Viruses
Anaerobes
H flu
Gram +ve rods
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12
Q

most common causes of nococosmial pneumonia

A

S. aureus,

P aeruginosa

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13
Q

Most common cause of Pneumonia in Dm and Alcoholic pt.’s

A

Klibsielle Pneumonia

currant-jelly sputum

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14
Q

Pt.’s with Dm should get

A

annual Flu vaccine and pneumococcal pneumonia–> DM inhibits the protective proteins in airways…very susceptible to Flue and its effects….worse immune system as well

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15
Q

is there vaccines againts staph

A

no

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16
Q

is there vaccines against pneumococcal pneumonia

A

yes–> strep. pneumonia

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17
Q

transplant pt.’s are also susceptible to

A

CMV infection

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18
Q

gram negative aerobe that thrives in water environment

A

legionella pneumophilia

–> atypical causative agent for pneumonia

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19
Q

name the respiratory quinolones

A

levofloxacin
cipro
moxifloxacin
*acheive good levels in lung tissues

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20
Q

commonly employed for legionella

A

azithromycin, clarithromycin

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21
Q

method for tx of penumonia

A

catergorize based on demographics
treat with broad spectrum pending labs
(take into account individual pt., resistance, local microbe info)

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22
Q

Outpatient no other modifying factors

A

Macrolide of doxycycline

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23
Q

Outpaitient with COPD, no steroids of Antibiotics in 3 months

A

2 gen macrolide

(clarithromycin) or doxycyline

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24
Q

Outpaitient, COPD, steroids or antibiotics in three months

A

floraqunolone, or augmentin, or clarithromycin (2nd gen.) +/- cephalosporin

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25
Q

Nursing home

A

floraqunolone, or augmentin, or clarithromycin (2nd gen.) +/- cephalosporin

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26
Q

Hospital Ward

A

floraqunolone, or augmentin, or clarithromycin (2nd gen.) or azithromycin (3rd gen.) +/- cephalosporin

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27
Q

ICU first option

A

3rd gen cephalosporin+/- macrolide or piperacillin (broad)/tazobactam or floroquinilone

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28
Q

zosyn

A

piperacillin/tazobactam (beta lactamase inhibitor)

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29
Q

ICU with risk of P aeruginosa

A

antipsuedomonal florquinolone (cipro) + beta actam or

macrolide + 2 antipseudomonal agents

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30
Q

why adjust for recent seroid use

A

pt. assumed to have realignment of local flora

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31
Q

MOA for macrolides

A

50s ribo blocker–>prevent translation

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32
Q

MOA for tetracyclines (doxycycline)

A

30s ribosomal blocker–> inhibts protein synthesis

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33
Q

MOA for floroquinolones

A

DNA gyrase inhibitor–> prevents DA repication

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34
Q

Penicillin MOA

A

block cell wall cross linkage

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35
Q

MOA for carbapenem

A

blocks cell wall cross-linkage

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36
Q

MOA for cephalosporins

A

inhibit cell-call cross-linkage

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37
Q

3rd gen cephalosporin with anti-pseudomonal activity

A

cefepime

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38
Q

MOA for aminoglycosides (gentamicin)

A

30s ribosomal inhibitor

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39
Q

resistance mech. for macrolides

A

mutation of 23s rRNA, ribosomal methylation, active efflux

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40
Q

tetracyclines restance mech.

A

decreased entry/increased efflux, target insensitivity

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41
Q

resistance mech to floroqiunolones

A

mutation of DNA gyrase, active efflux

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42
Q

resistance mech. to cephalosporins

A

dereased permeability of gram negative outer membrane (altered porins), ective efflux

43
Q

resistance mech for aminoglycosides

A

drug inativation (aminoglycoside modfying enzyme)
dec perm of gram negative outer membrane
active efflux
ribosomal methylation

44
Q

most common nocosomial organism

A

Staph aureus, p aeruginosa

45
Q

drugs indicated in NOCOSOMIAL pneumonia

A
  1. imipenem/ cilastin–> meropenem
  2. axtreonam–> zosyn
  3. ceftazidime–> cefepime
  4. vancomysin (IV)
46
Q

carbapenem with less side effects

A

meropenem

47
Q

drug reserved for cetazidime resistant

A

cefepime-> 4th gen and anti-pseudomnal

48
Q

50% of isolate for pt.’s with aspiration pneumonia are…

A

gram negative bacteria

  • 16% anaerobes
  • 12% staph aureus
49
Q

risks factors for aspiration pneumonia

A

Unconsiousness–> loss of protective reflexes
long term intubation
foreign body
gastric acid
semi-recumbant positioon and unable to expectorate material in airway

50
Q

indicated in aspiration pneumonia

A

clindamycin–> ampicillin/sulbactam

51
Q

tx for aspiration pneumonia must include protection against

A

anerobes such as H. flu

52
Q

MOA for clindamycin

A

50s ribosomal inhibitor blocking translocation

53
Q

resistance mech for clindamycin

A

meythlation of binding site, enzymatic inactivation

54
Q

Vancomycin MOA

A

Bind D-ala-D-ala terminus of peptide precursor units, ihibiting peptidoglycan polymerase and transpeptidase reaction (cell wall proliferation inhibitor)

55
Q

resistance to VANC

A

replacement of D-ala by D-lactate

56
Q

Vancomycin only works on

A

gram positive bacteria

57
Q

dosing route consideration for Ab’s

A

oral for mild infections (no Gi problems, adherent, other chelating drugs)–> parenteral is severe–> may swithc to oral when controlled

58
Q

Ab’s with highest oral bioavailability

A

Florquinolones and doxycycline

59
Q

three major relationships to consider when choosing a medication for pneumonia

A
  1. AUC/MIC
  2. Cmax/MIC
  3. T>MIC
60
Q

dosing parameters for concentration dependent drugs

A

large doses relative to MIC at long intervals relative to serum half life

61
Q

example of concentration dependent drugs and their dosing

A

once daily aminoglycosides

2g of have with pt.s in normal renal function

62
Q

time dependent dosing parameters

A

dosed more frequently, with emphasis on the need to maintain serum drug level above MIC for 30-50% of dose interval

63
Q

example of time dependent meds

A

constant infusion of beta lactams to ensure maximal T>MIC

64
Q

T>MIC greatest consideration for

A

penicillins, cephalosporins, carbapenems

65
Q

24 hour AUC/MIC greatest consideration for

A

aminiglycosides, floroquinolones, tetracylines, vancomycin, macrolides, clindamycin

66
Q

cMAX/MIC greatest consideration for

A

aminiglycosides. floroquinolones

67
Q

which drugs DO NOT REQUIRE DOSE ADJUSTMENT FOR RENAL IMPAIRMENT
(entirely billiary or renal/billiary)

A

azithromycin, ceftriazone, clindamycin, dxy, erythromycin, linezolid
(all others do require adjustment)

68
Q

drug with renal metabolism not just exceretion

A

imipenem

69
Q

ab’s metabolized by liver cyp’s

A

linezolid

70
Q

Major toxicity for amoxicillin

A

cross reactive with penicillin sensitivity,

71
Q

ampicillin toxicity

A

maculopapular rash

72
Q

azithromycin toxicity

A

QT prolong, chelestatic jaundice

73
Q

cefazolin cross-reactivity

A

complete cross reactivity within cephalosporins, penicillin cross-reactivity

74
Q

doxycylcine toxicity

A

teeth discoloration, dec bone growth, photosensitivity

75
Q

erythromycin toxicity

A

cyp 3A4/pgp inhibitor, QT prolong, cholestatic jaundice

76
Q

gentamicin toxicity

A

nephro and ototoxicity, neuromuscular paralysis

77
Q

imipenen toxicity

A

cross-reactive with penicillin, cephalosporin toxicity

78
Q

levofloxacin toxicity

A

tendon rupture in adults, cartilage damage in young children

79
Q

linezolid toxicity

A

non-specific MAO inhibitor

80
Q

meropenem toxicity

A

cross-reactive with pen/ceph

81
Q

piperacillin toxicity

A

cross reactive with ceph, decreases coagulation (bleeding tendencies)

82
Q

vancomycin toxicity

A

neophro and ototoxicity, Red Man’s syndrome

83
Q

cross reactivity related to…

A

presence of beta lactam ring that is rpesent in multiple drug classes

84
Q

augmentin

A

amoxicillin/clavulonate

85
Q

zosyn

A

pieracillin/tazobactam

86
Q

unasyn

A

ampicillin/sulbactam

87
Q

benefit of conjugating with a bactam/clavulonic

A

increases the duration of the effect of the beta lactam antibiotic by irreversibly inhibito the beta-lactamases

88
Q

primaxin

A

imipenem/cilastin

89
Q

Cilastin MOA

A

Reversible, competitive inhibitor of renal DHP-1, an enzyme which breaks down imipenem to inactive but nephrotoxic metabolites

90
Q

antibiotic not used for pulmonary infections

A

daptomycin (cubicin)

91
Q

why is daptinomycin not used for pneumonia

A

though it distributes to lung tissues…this drug is inhibited by pulmonary surfactant

92
Q

Bronchitis in young people

A

viral

93
Q

Bronchitis in elderly patients with other comorbitities

A

bacterial

94
Q

common bugs that cause acute bronchitis in the elderly

A

Mycoplasma pneumonia, strep pneumonia, H flu, Moraxella catarrhalis and Bordatella pertusis

95
Q

most common cause of acute bronchitis in smokers

A

H. influenza

96
Q

indicated drugs in acute bronchits

A
  1. augmentin–> ciprofloxacin if resistance
  2. azithromycin
  3. clarithromycin
  4. doxycycline
97
Q

Lung Abcesses most likley cuased by

A

Anaerobes
+ gram negative cocci
+ gram positive bacilli

98
Q

nocosomial lung abcesses

A

gram negative bacilli

99
Q

community acquired lung abcesses

A

gram positive cocci

100
Q

treatment for lung abcesses

A
  1. clinda mycin (better than penicillin vs. bacteroides)

2. metronidazole + ceftriaxone (for nocosomial infections)

101
Q

gram negative lung abcesses

A

metronidazole + ceftriaxone

102
Q

gram positive cocci lung abcesses

A

clindamycin

103
Q

List the tx for CAP in order of preference

A

Macrolide or respiratory quinilone
or
amoxicillin/clavulonate

104
Q

treatment for abcess and aspiration pneumonia should cover for

A

anaerobes

Pulmonology (10 decks)

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