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Pharmacology > Treatment of Respiratory Tract Infections > Flashcards

Treatment of Respiratory Tract Infections Flashcards

1
Q

tx of maligant EO

A

must use Ab that cover pseudomonas - main cause of MEO

  • 1st line: CIPROfloxacin, LEVOfloxacin
  • if flouroquinilones C/I
    • pt then hospitalized to be given:
      • IV B-lactam
        • piperacillin-tazobactam, cefe_pime,_ certazidime
      • if ESBL (B-lactam resistant)
        • meropenem, imipenem-cilastin
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2
Q

what to give for malignant OE if pt cant take flouroquinilones because of AEs/ are C/I?

A

example: tenosynovitis, glucose dysregulation, long QT interval

next choice is: B-lactams with pseudomonas coverage:

  • piperacillin-tazobactam
  • “pime and dime”

if psuedomonas resistant to B-lactams: meropeneum, imapenem

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3
Q

otitis media tx

A

ab must cover s. pneumonia, h. influenza, m. catarrhalis

  • amoxicillin - 1st line
  • if allergic to penicillins: cef_dinir,_ cefpodoxime (oral 3rd gen cefs)
  • if allergic to all B-lactams: doxycycline
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4
Q

what is the most common reason for treatment failure of otitis media?

what do we prescribe next?

A

h. influenza & m. catarrhalis produce penicillinases & cephalosporinases, knmocking out 1. amoxicillin and 2. cefdinir, cefpodoxin

give:

  • amoxillin-_clavulante_
  • doxycyline
    • 3rd choice for OM anyways
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5
Q

tx acute sinusitis

A

must cover s. pneumonia, h. influenza, m. catarrhalis -same as OM*. thus, Ab are same as OM.

  • amoxcillin / amoxicillin-clauvulante*
  • cefdinir, cefpodoxine
  • doxycyline
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6
Q

chronic sinusitis tx

A

must cover s. aureus & anaerobes. this happens to be same Abs that cover OM & acute sinusitis.

  • amoxicillin-clavunate
  • cefdinir, cefpodoxime + clinda / metro
  • doxycyline
  • resp flouroquinilone + clinda / metro
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7
Q

treatment of OM vs acute sinusitis vs chronic sinusitis

A

all the same: amoxcillin top choice, then cefdinir/cefpodoxinme if allergic to B-lactams, then doxy if allergic to cephs.

difference is that amoxicillin-clavaunte is more of a top choice in sinusitis, whereas is it givin in OM only after treatment failure.

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8
Q

tx for COPD exacerbation?

A

m/c agents of COPD exacerbation are OM agents - s. pneumonia, h. influenza, m. catarrhalis + legionella –> macrolides cover legionella

  • OUTPATIENT
    • amoxcillin-clauvante + azithromycin/clarithromycin (macrolides)
    • doxycyline
    • resp. flouroquinilone
  • INPATIENT
    • ceftriaxone/ceftaxime (IV)+ azithromycin
    • resp flouroquinilone
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9
Q

outpatient tx of exacerbation COPD

A

similar to OM tx but,

  1. must include for legionella –> macrolides: azithro_mycin,_ clarithromycin
  2. oral 3rd gen cefs (cefdinir, cefpodox) not a good choice.
  • amoxicillin-clauvanate + azithromycin/clarithromycin
  • doxycyline
  • resp. flouroquinilone
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10
Q

inpatient tx for COPD exacerbation

A

3rd gen IV ceph + legionela coverage

  • ceftriaxone/cefotaxamine + azithromycin
  • resp flouroquinilone
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11
Q

most common causes community aquired pneumonia (CAP)?

A
  • viruses overall m/c
  • bacteria
    • in adults: strep pneumonia
    • in chidlren: mycoplasma pneumonia
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12
Q

outpatient tx of community acquired pneumonia (CAP)

A

for empiric coverage (i.e., knocking out all possible pneumonia agents if we dont know the exact cause)- give:

  1. doxycyline, or
  2. lefamulin, or
  3. levofloxacin/moxifloacin
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13
Q

outpatient tx for CAP if pt has already been Ab on 3 months?

A
  • azithromycin + amoxicillin-clavulanate (1st choice)
  • doxycyline + axmocillin-clavulanate
  • lefamulin + amoxcillin-clavunate

next two choices given if pt has macrolide resistance > 20%

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14
Q

inpatient treatment for CAP?

A
  • ceftriaxone + azithromycin/doxycyline
    • doxy if macrolide resistance ? 2-
  • lefamulin
  • levofloxacin or moxifloxacin
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15
Q

what ab can be used for both outpatient and inpatient CAP?

A

both:

  • lefamulin
  • levo/moxi - floxacin

outpatient only:

  • doxycycline alone

inpatient only:

  • doxycyline + ceftriazone
  • azithromycin + ceftriazone
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16
Q

what pneumonia Abs are contraindicated in pregnancy?

A
  • doxycyline
  • lefamulin
  • levo,moxi - flxacin
17
Q

recommended Ab for CAP in pregnancy?

A

outpatient: amoxicillin-clavulanate + azithromycin

  • same top choice as outpatient tx for 3-mos Ab use pt
  • if penicclin allergy - replace amoxcilin w/ clindamycin

inpatient: ceftriaxone + azithromycin
* same top choice as any inpatient

cant use doxy, lefamulin, levo/moxi-floxacin

18
Q

tx for hospital aquired pneumonia (HAP)?

A

since HAP assumes MRSA infection:

ALL TREAMENTS involve vancomycin + an additional drug dependent on the risk of psuedomonas.

  • no psueodmonas risk: vancomycin + ceftriaxone/ceftaxamine
  • pseudomonas risk: vancomycin + piperacillin tazo/cefepime/levofloxacin
  • MDR psueodmonas: vancomycin + meropenem + gentamycin/levofloxacin
19
Q

what can replace vancomycin in tx of hospital acquired pneumonia (HAP)?

A

linezolid

20
Q

in addition to vanc, what Ab is in every regimen for MDR psueodmonas HAP?

A
  • meropenem (m for MDR)
    • can be replaed with imipenem
21
Q

what flouroquinilone does NOT cover psuedomonas?

A

moxifloxacin

22
Q

what carbapenems can NOT be for psuedomonas pneumonia?

A
  • ertepenem - doesnt cover pseudomonas
  • doripenem - absolutely C/I in all respiratory disease (esp pneumonia)
23
Q

treatment for ventilator associated pneumonia (VAP)?

A

VAP assumes MRSA AND assumes psueodmonas infection

  • general peudomonas infection: vancomycin + cefepime/levofloxacin
  • MRD: vancomycin + meropenem + gentamycin/levocloxacin
24
Q

tx of HAP pneumonia vs VAP pneumonia

A

similar, except:

  1. vancomycin + 3rd gen ceph (ceftax, ceftriax) NOT an option for VAP, ,since VAP assumes psuedomonas and requires coverage
  2. vancomycin + piperacillin tazobactam not an option for VAP
  • VAP tx:
    • vancomycin + cefepime/levofloxacin (not MDR)
    • vancomycin + meropenem + gentamycin/levocloxacin (MDR)
25
Q

which B-lactams do NOT interact with probenacid?

A
  • ceftriaxone
  • aztreonam
26
Q

important AEs of penicillins

A
  • imipenem - seizurfes
  • aztreonam - neutropenia, thrombocytopenia
27
Q

vancomycin

  • MOA
  • coverage
  • how do bacteria become resistant to it/what drug to use in this case
A
  • blocks PBP from transpeptidase reaction
  • coverage: gram + cocci incuding MRSA)
  • resistance:
    • terminal alinine it binds to mutated to serine/lysine
    • use linezolid
28
Q

vancomycin AEs and C/Is

A
  • red man syndrome - avoid by pre-treating pt with anti-histamine
  • nephrotoxicity
    • careful with vanc, diuretics
29
Q

aminoglycosides

  • MOA
  • coverage
  • key uses
  • AEs, C/I
A
  • MOA: binds irreversibly to 30s subunit (bacteriacidal)
  • coverage: gram -: e. coli, klebsiella, psuedomonas
  • use: to “double cover” pseudomonas in HAP/VAP (gentamycin)
    • ​i.e. for MDR as part of vanc + meropenem regimen
  • nephrotoxicity
    • careful with vancomycin
    • C/I amphotericin, diuretics (furosemide)
  • otoxicity
    • C/I diruetics (furosemide)
30
Q

doxycyline

  • MOA
  • coverage
  • AE/CI
A
  • MOA: reversibly bind to 30s subunit to block tRNA (bacteriostatic)
  • coverage: lots of shit plus weird pneumo - mycoplasma pneumonia, clamydia pneumonia, legionella
  • AE
    • GI
    • photosensitivty
  • CI
    • pregnancy
31
Q

macrolides AEs/drug drug interactions

A

AEs

  • GI problems
  • QT elongation

drug-drug interactions:

  • clarithromycin: CYP -3A4 inhibitor –> will increase plasma [] of CCBs, colchicine, statins, clindamycin
  • all macrolides: LQT drugs (Ia & III antiarrthmics, flouroquinilones)
32
Q

cindamycin

  • key uses
  • PK
  • AEs / drug drug interactions
A
  • key use:
    • as a tx for CAP in pregnant women: clinda + azithromycin
    • as a backup for amoxicillin-clavulanate
  • PK - metabolized by CYP 3A4
  • drug-drug interactions
    • CYP-3A4 inhibitors & inducers (CIVIK)
  • AE –> c. diff psuedomembrane colitis
33
Q

linezolid

  • MOA
  • coverage
  • use
  • AEs
  • drug-drug interactions
A
  • bind reversibly to 50s subunit (bacteriostatic)
  • coverage: gram + only
  • use: to replace vancomycin in tx in HAP & VAP
  • AEs:
    • thrombocytopenia/ anemia
    • MOA/SSRI inhibition –>
      • hypertensive crisis
      • serotonin syndrome: irritibitliary, seizures
  • drug-drug interactions:
    • SSRIs/MOA-I antidepressants
    • pseudophedrine
34
Q

what drugs cause prolonged QT interval?

A
  • flouroquinilones
  • macrolides
  • lefamulin
  • televancin
  • Class Ia and III anti-arrhythmic
35
Q

what are the CYP-3A4 inducers?

A
  • nafcillin
  • rifampin
  • carbamazepine
36
Q

CYP - 3A4 inhibitors

A

clarithromycin, isoniazid (TB dru, voriconazole, itraconizole ketoconiazole (CIVIK)

37
Q

lefamulin

  • MOA
  • PK
  • AE
  • drug drug
A
  • inhibits peptidyl transferase (bacteriostatic)
  • PK
    • take > 2 hrs before/after eating
    • metabolized by CYP-3A4
  • AE
    • diarrhea
    • QT prolongation –> torsades
  • drug drug interactions
    • other LQT drugs
    • CYP-3A4 inducers/inhibitors
38
Q
  • flouroquinilones
    • MOA
    • PK
    • AEs/ drug-drug interactions
A
  • bind to topiosomerase II (DNA gyrase) and IV (bactericidal)
  • PK - n/a
  • AEs
    • tendonitis/tendon rupture
    • aortic anurysm
    • gucose dysegulation
    • pseudomembranous colitis
    • QT elongation
  • CI:
    • pregnancy
    • children < 16
  • drug drug interactions:
    • clindamycin - colitis risk
    • LQT drugs

Pharmacology (4 decks)

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