Wolff cardiopulm infection - crossword Flashcards
notable among the “cefs” for being ~only agent eliminated by the liver rather than the kidneys
ceftriaxone
common reason for adding vancomycin or linezolid to pneumonia, both during empiric therapy and lab-guided therapy; ceftaroline also has activity
MRSA
4th gen cephalosporin meaning it has greater gram negative outer membrane penetration, active against psudomonas
Cefepime
macrolide-like with 15-aom ring, does not block cytochrome P450 and has unusual pharmacokinetics in that a single dose becomes concentrated in cells, especially phagocytes, and is then solwly released at bacteriostatic levels over several days to give it a half-life of 3-4 days
Azithromycin
Risk of this is increased by some cephalosporins
Bleeding
Neuraminidase inhibitor effective against influenza A and B, administered IV and having a longer half-life, it can reduce the severity and duration of the flu by 1-2 days if administered within 48 hrs
Peramivir
3rd gen fluoroquinolone, “respiratory” activity but also useful against Pseudomonas
Levofloxacin
Important consideration when toxic drugs requiring monitoring are administered IV over short periods of time (30 min); in the case of gentamicin with irreversible effects on bacterial ribosomes, the concentration needs to be high enough to reliably exert those effects but then low enough as indicated by this to allow for the toxic drugs to exit the host cells (eg proximal tubules, vestibulocochlear hair cells) where they can exert deleterious effects
Trough
Overgrowth of this anaerobe can occur in GI tract when broad spectrum abx are administered, leads to severe diarrhea, can be a major problem in healthcare facilities, and has a worrisome mortality rate
C. difficile
Characterized as an extended spectrum penicillin because of its activity against P. aeruginosa, used in both CAP and HAP when pseudomonas is a concern
Piperacillin
An orally active and inexpensive ergosterol synthesis inhibitor, and drug of choice for yeast infections; has no activity against molds
Fluconazole
Aminoglycoside used to treat community-acquired pneumonia in hospitalized pts with severe beta-lactam allergy and in those who acquired pneumonia in hospital (eg VAP or HAP) when there is concern for multi-drug resistant gram-positive and/or gram-negative infections
Gentamicin
Gram-positive cause of endocarditis more commonly than cause of pneumonia, vancomycin is indicated if the endocarditis does not respond to beta-lactams
Enterococcus
A penicillin-binding protein drug notable for having useful activity only against gram-negative aerobic pathogens including Pseudomonas; a monobactam held in reserve for treating more serious infections such as HAP and VAP
Aztreonam
A 4th gen “respiratory” fluoroquinolone
Gemifloxacin
Crucial bacterial enzyme preferentially blocked by 1st and 2nd gen fluoroquinolones and is arguably the main target that makes fluoroquinolones active against susceptible gram-negative infections
DNA gyrase
Acronym for the multidrug resistant bacterial of greatest concern, members are responsible for ~80% of ventilator-associated pneumonia
ESKAPE E. coli Staphylococcus pseudintermedis/schleiferi/aureus Klebsiella Pneumonia Acinetobacter Baumannii Psuedomonas Aeruginosa Enterococcus Faecalis/Faecium
minimum number of drugs required to treat multi-drug resistant TB
Five
Getting the annual version of this vaccine is the best protection against the virus
Influenza
Among the respiratory pathogens for which there is no preventative therapy
Adenovirus
An orally administered 2nd gen cephalosporin
Cefaclor
Development of a candida infection here
Prosthetic valve
Notable among the 3rd gen cephalosporins for having activity against Pseudomonas
Ceftazidime
Can rupture during fluoroquinolone therapy, especially in the young, old, and in others who subject them to significant stress
Tendons
Also exhibited by erythromycin, further extends its spectrum of potential drug interactions
P Glycoprotein
Used in first-line treatment cocktail for active TB and sometimes for tx of latent TB
Rifampin
Negatively impacted in the weight-bearing joints of immature animals by fluoroquinolones, the potential for damage to it is a reason to avoid fluoroquinolones in children if possible but case-by-case benefits may outweigh risks
cartilage
Prototype of recent echinocandin antifungal drug class, it weakens fungal cell walls by blocking glucan crosslinking
Caspofungin
Well-known adverse effect of aminoglycosides, can be exacerbated by other drugs such as furosemide
Ototoxicity
Refers to multi-drug resistant strains of enterococcus that will still hopefully respond to linezolid
VRE (vancomycin-resistant enterococci)
5th gen cephalosporin, spectrum much like 3rd gen with addition of activity against MRSA
Ceftaroline
In addition to rare but serious CNS adverse effects including psychosis, seizures, and memory loss, levofloxacin has a black box warning due to its potential exacerbation of _______
Myasthenia Gravis
Principal cause of tricuspid valve endocarditis, creates a population of patients that is especially challenging to treat
Injection drug use
Well known adverse effect of tetracyclines, but fluoroquinolones and voriconazole are among other agents that also cause this
Photosensitivity
Drug class preferred for addition to beta-lactam antibiotic for treating community acquired pneumonia
Macrolide
Syndrome caused by infusing vancomycin too fast, generally does not cause hypotension, shortness of breath, etc but draws attention
Redman
Metabolizes a number of abx and many other drugs which therefore predisposes to many unwanted drug interactions
CYP3A4
characteristic of Mycobacterium tuberculosis growth that makes it hard to kill
slow
Ideal status of respiratory fluoroquinolones in the treatment of CAP
Reserve
generally more effective than tetracyclines or macrolides for pneumonia, but
should be reserved to minimize appearance of tolerance
– use is discouraged in ambulatory patients with CAP unless:
• comorbid conditions
• recent antimicrobial use
• high prevalence of high-level macrolide-resistant S. pneumoniae in the local community
– fluoroquinolones continue to be given, often inappropriately, for CAP
Acronym used for nosocomial pneumonia; ie, that acquired in hospital where multiresistant strains of microbes are more prevalent and the leading cause of infection-related death in hospital
HAP
Orally administered 1st gen cephalosporin, this class has better gram-positive activity than 2nd gen
Cephalexin
Organ adversely affected to varying degrees by many abx drugs including macrolides, fluoroquinolones, azole antifungals and several anti-tuberculosis agents
Liver
Ergosterol synthesis inhibitor with activity against aspergillus, blastomycoses, and histoplasmosis along with other fungal infections, has a black box warning due to its negative inotropic effects that can precipitate/worsen heart failure
Itraconazole
Can occur in topoisomerases to render them insensitive to fluoroquinolones, a reason abx stewardship is so important for this class of drugs
Mutations
Among the safest abx, allergic reactions are the biggest problems
Penicillins
Orally-administered penicillin, an agent of choice for CAP and multiple other infections
Amoxicillin
Enzyme inhibited by linezolid, responsible for rather unusual adverse effects for and abx including serotonin syndrome
MAO - monoamine oxidase
Susceptible to treatment by newer agents posaconazole and isavuconazole but not to voriconazole
Mucormycosis
Has high affinity for ergosterol leading to pore formation in fungal cell membrane, standard treatment for many severe invasive fungal infections but multiple significant adverse effects
Amphotericin b
At least 4 ____ must pass with daily drug administration for most endocarditis treatment regimens
weeks
Initial indication was for its antiviral activity against influenza A (not B), no longer recommended but likely to still show up in textbooks; now used primarily to treat Parkinson disease
Amantadine
S. pneumoniae vaccine administered to newborns at 2, 4, 6 and 12-15 mo, and sometimes to those >age 65
Prevnar 13
Among the “biggest guns,” stable against beta-lactamases and having a wide spectrum of gram-positive and gram-negative activity, abx stewardship dictates that it is kept in reserve for use against microbes cannot be killed with narrower spectrum abx (ie, microbes that are multi-drug resistant)
Imipenem
MRSA and metronidazole-resistant C. difficile infections are reasons to use this abx, but IV and orally, respectively
Vancomycin
Well known adverse effect of aminoglycosides, can be exacerbated by other drugs
Nephrotoxicity
Not a substitute for vaccination, this generally well-tolerated antiviral with activity against influenza A and B exerts its effects by blocking an ednonuclease that is required for the viral gene transcription
Baloxavir
Inhaled neuraminidase inhibitor that can hasten recovery from flu if administered within 48 h of symptom onset
Zanamivir
Lacking in mammalian cells but constructed from peptidoglycan in bacteria, the crosslinking component of its synthesis is blocked by beta-lactam abx making it essential for their efficacy
cell wall
Should not be consumed with tetracycline drugs because of precipitates that form in the GI tract and disrupt drug absorption
Milk
Common invasive fungal mold infection, especially in neutropenic patients where it can manifest as fever, chest pain, shortness of breath, etc. OR just fever with imaging evidence of pulmonary nodules? can cause a chronic slowly progressive pulmonary disease with pulmonary infiltrates and cavities
Aspergillus
Name given to bacterial pulmonary infections that develop secondary to viral infections or when there is an overgrowth of selected bacteria that are not susceptible to broad spectrum abx
Superinfection
AKA penicillinase, clavulanate, tazobactam, and sulbactam are among the agents added to abx therapies to inhibit this
beta lactamase
Refers to formulation of amphotericin B in which the drug is administered in 100 nm phospholipid vesicles in an effort to minimize its adverse effects
Liposomal
acronym that means the pneumonia developed after the pt required mechanical ventilation
VAP
Component of first drug cocktail used to treat active TB and the typical agent used prophylactically in those with latent TB
Isonazid
Target of multiple drugs with antimicrobial selectivity, also means a cell wall is not required for it to work
Protein synthesis
Macrolide with less epigastric pain than erythromycin, but does block cytochrome P450
Clarythromycin
Adding activity against these bacteria is what makes ampicillin and amoxicillin “broad spectrum” penicillins
gram-negative
This for a cultured bacterial pathogen to abx is determined either by a disk diffusion assay or by 1:2 dilutions of abx in a 96-well plate
susceptibility
Reason gram-negative cells are gram-negative and serves as a barrier to many abx
outer membrane
Responsible for the elimination of many abx that often do not undergo metabolism such as beta-lactam abx, for example, as well as some drugs that have undergone metabolism; insufficiency of this organ frequently necessitates changes in drug dosage
Kidney
A 2nd gen cephalosporin given parenterally and also orally as its “axetil” prodrug
Cefuroxime
Metabolized to a pyridine analog that disrupts
Flucythosine
Broad spectrum orally available class of drugs with activity against gram-neg bacteria; current agents now also target gram-pos bacteria
Fluoroquinolones
Category of abx that generally should not be administered at the same time as bactericidal drugs, but happens when doxycycline and beta-lactams are combined to treat pneumonia
Bacteriostatic
Macrolide that is a frequent substitution for penicillin can cause epigastric pain and is a “classic” inhibitor of CYP3A4 and p-glycoprotein meaning that it has many drug interactions
Erythromycin
Refers to micro-organism strains that are resistant to all abx that might otherwise be used against them, so totally reliant on immune system to clear from body
Pan-drug-resistant
3rd gen cephalosporin administered as a pro-drug that can be used for outpatient therapy of community acquired pneumonia
Cefpodoxime
Often does not require adjustment for ceftriaxone when there is kidney or liver failure because it undergoes elimination by both organs
dosage
Orally active and also administered parenterally, this bacterial protein synthesis inhibitor agent is orally active against most gram-pos pathogens including methicillin-resistant staphylococcus and vancomysin-resistant enterococcus
Linezolid
2nd gen cephalosporin, a cephamycin administered parenterally, not in notes but cephamycins tend to have better activity against anaerobes when compared to other cephalosporins
Cefotetan
Tetracyclines turn them gray/brown while developing
teeth
Member of the newer echinocandin class of antifungal agents with excellent activity against invasive yeast infections, it also has few adverse effects especially when compared to amphotericin B
Micafungin
Careless use of abx here has contibuted to the development of abx resistance
Agriculture
approaches 100% when aspergillus mold is the cause of endocarditis
Mortality
infection for which UpToDate recommends monotherapy with voriconazole as the initial therapy
Invasive aspergilliosis
Was a drug of choice for aspiration pneumonia due to its spectrum of activity that includes most anaerobic bacteria (eg abundant in oral cavity); frequent cause of C. difficile colitis on exam questions
Clindamycin
Active against aspergillus mold and fluconazole-resistant yeast, this ergosterol synthesis inhibitor has some unique adverse effects for the class including a propensity for causing flashes of light in many at lower doses and visual hallucinations at higher doses
Voriconazole
Yeast that is the most common fungal cause of endocarditis; initial therapy is liposomal amphotericin B +/- flucytosine or a high does of an echinocandin
candida
the only route by which fixed-charge drugs such as gentamicin and large abx such as the glycopeptide vancomycin can reach the bloodstream? but can be a convenient/quick route when patients are hospitalized
Parenteral
Parenteral 1st gen cephalosporin, this class has better gram-pos activity than 2nd gen
Cefazolin
Type of pneumonia seen more often in the very young, elderly, and - in its more severe forms - those who are immunocompromised
viral
Beta-lactam-containing abx divided into 5 generations
Cephalosporins
Component of 1st drug cocktail used to treat active TB, it is the only agent in the cocktail that does not have hepatic injury as a worrisome adverse effect
Ethambutol
A tetracycline useful in combination with a beta-lactam for CAP in those who cannot tolerate a macrolide, its low pH can cause local damage - esophageal ulceration
Doxycycline
Refers to a large group of commensal gram-pos streptococci that are alpha-hemolytic, producing a green discoloration on blood agar plates? these critters can cause endocarditis that responds to IV ampicillin of ceftriaxone over 4 weeks unless/until there is abx resistance
viridans
Arguably the primary target of 3rd and 4th gen fluoroquinolones that expands their coverage to include gram-pos bacteria (makes them “respiratory” fluoroquinolones)?
this enzyme is crucial during bacterial cell division for separating their replicated circular DNA (ie newly replicated rings are cross-linked)
Topoisomerase IV
Penicillinase-resistant penicillin
Nafcillin
Used in 1st line tx cocktail for TB, exact mechanism of action is unknown? and is hepatotoxic
Pyrazinamide
Vaccine against a broader range of S. pneumoniae serotype, but does not elicit a satisfactory immune response in those younger than age 2 yrs? Recommended for those over 65 and younger people who smoke
Pneumovax 23
Among the 3rd gen abx administered orally to treat community acquired pneumonia, also is among the cephalosporins that increases INR
Cefditoren
At least 6 of these are required to pass with regular drug administration for successful treatment of TB, contributes to adherence challenges
6 months
A 4th gen “respiratory” fluoroquinolone
Moxifloxacin
A pleuromutilin with that unique mechanism of action, its only indication is CAP in patients with normal lung when other drugs are not effective
Lefamulin
Neuraminidase inhibitor effective against influenza A and B, it can reduce the duration of the flu by 1-2 days if administered within 48 h of the onset of influenza symptoms and be used prophylactically by those exposed to people with the flu
Oseltamivir
Regularly issues reports on the biggest abx resistance threats and guidelines for abx stewardship
CDC
Generation of cephalosporins that is especially useful in CAP bc of its wide spectrum against gram-pos and gram-neg bacteria and stability in the presence of beta-lactamases
Third
Component of mycobacterium tuberculosis cell wall that contributes to their resistance to disinfectants, detergents, common abx, dyes, stains, osmotic lysis, and lethal oxidation?
Queue classic Monty Python line from “Frenchman” at top of the castle
Wax
