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CPR II - EXAM 1 & 2 > Wolff - Drugs Used For Cardiopulmonary Infections > Flashcards

Wolff - Drugs Used For Cardiopulmonary Infections Flashcards

1
Q

What were the cardiopulmonary antiviral drugs discussed in this lecture

A 
Prevnar 13
Pneumovax 23
Influenza vaccine
Oseltamivir
Zanamivir
Peramivir
Baloxavir
Amantadine
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2
Q

_______ is a vaccine used for the prevention of invasive diseases caused by 13 different ______ pneumoniae strains.

A

Prevnar 13

Sreptococcus pneumoniae

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3
Q

The CDC recommends Prevnar 13 for who?

A
  1. All children < 2 yrs old
  2. Immunocompromised adults > 19 yrs old
  3. Adults 65 yrs or older
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4
Q

_______ is a vaccine used for the prevention of invasive diseases caused by 23 ______ pneumoniae strains.

A

Pneumovax 23

Streptococcus pneumoniae

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5
Q

What are the CDC recommendations for Pneumovax 23?

A
  1. All adults 65 yrs and older
  2. People 2-64 yrs old if immunocompromised
  3. Adults 19-64 yrs old who smoke cigarettes
  4. Single shot re-administered every ~5 yrs once started
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6
Q

What is the most common cause of viral pneumonia & what drugs discussed are used to treat it

A

Influenza

  1. Oseltamivir
  2. Zanamivir
  3. Peramivir
  4. Baloxavir

No effective drugs for the other common causes of pneumonia (Adenovirus, Parainfluenza, RSV)

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7
Q

Oseltamivir (Tamiflu)

  1. MOA
  2. Effects
  3. Clinical Applications
A
  1. Inhibits viral neuraminidase
  2. Hastens recovery from flu by 1-2 days
  3. Clinical Application:
    - Prophylaxis of influenza A or B infection in patients older than 1 y/o
    - Treatment of acute, uncomplicated illness of infleunza A & B in patients greater than 2 weeks of age
    - Stop use 2 days before flu vaccination
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8
Q

Distinguish Zanamivir and Peramivir

A

Both similar to Oseltamivir

Zanamivir: Given via oral inhalation which leads to a risk of bronchospasm

Peramivir: Given IV and it not significantly metabolized

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9
Q

Baloxavir (Xofluza)

  1. MOA
  2. Effects
  3. Clinical Applications
A
  1. Inhibitor of endonuclease activity leading to blockage of viral replication
  2. Hastens recovery from flu by 1-2 days
  3. Clinical Application:
    - Prophylaxis of influenza A or B infection in patients older than 12 y/o
    - Treatment of acute, uncomplicated illness of influenza A & B in patients greater than 12 years of age
    - Stop use 2 days before flu vaccination
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10
Q

What drug was initially used as a prophylaxis for influenza A and hastens recovery from flu by 1-2 days but is not used to treat Parkinson disease

A

Amantadine

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11
Q

For community acquired pneumonia (CAP) What is the first line of action if the following risk factors are absent and they are not allergic/intolerant to Penicillin

Major comorbidities
Recent antibiotic use
Older age (65+)
Smoker
Alcohol dependent
A

Amoxicillin + macrolide (preferred) or doxycline

  • Macrolide (Azithromycin, Clarithromycin)
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12
Q

For community acquired pneumonia (CAP) What is the first line of action if the following risk factors are absent but they are allergic/intolerant to Penicillin

Major comorbidities
Recent antibiotic use
Older age (65+)
Smoker
Alcohol dependent
A

If they can use Cephalosporin - Third generation cephalosporin + Macrolide (preferred) or doxycycline

Can’t use Cephalosporin - Respiratory fluoroquinolone or Lefamulin

  • Macrolide (Azithromycin, Clarithromycin)
  • Respiratory fluoroquinlones (Levofloxacin, Moxifloxacin, Gemifloxacin)
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13
Q

For community acquired pneumonia (CAP) What is the line of action if the following risk factors are present and they are not allergic/intolerant to Penicillin

Major comorbidities
Recent antibiotic use
Older age (65+)
Smoker
Alcohol dependent
A

Amoxicillin-clavulanate + Macrolide (preferred) or doxycline

  • Macrolide (Azithromycin, Clarithromycin)
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14
Q

For community acquired pneumonia (CAP) What is the line of action if the following risk factors are present but they are allergic/intolerant to Penicillin

Major comorbidities
Recent antibiotic use
Older age (65+)
Smoker
Alcohol dependent
A

If they can use Cephalosporin - Third generation cephalosporin + Macrolide (preferred) or doxycycline

Can’t use Cephalosporin w/ structural lung disease (COPD) - Respiratory fluoroquinolone

Can’t use Cephalosporin w/o structural lung disease (COPD) - Respiratory fluoroquinolone or lefamulin

  • Macrolide (Azithromycin, Clarithromycin)
  • Respiratory fluoroquinlones (Levofloxacin, Moxifloxacin, Gemifloxacin)
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15
Q

What is the only indication for Lefamulin IV

A

Community acquired penumonia.

Works when others don’t due to unique, slowly developing resistance mechanism

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16
Q

What was the MOA and use of early generations of fluoroquinolones. What is the preferred antibiotic?

A

MOA - Inhibition of DNA gyrase
USE - Killing gram-negative bacteria
Preferred antibiotic - Ciprofloxacin

17
Q

What was the MOA and use of later generations of fluoroquinolones. What is the preffered antibiotic?

A

MOA - Blockade of Topo IV
USE - Killing gram positive organisms such as streptococcus
Preferred antibiotic - Respiratory fluroquinolones

18
Q

_____ remain the first choice antibiotics and are among the safest. They should not be combined in same IV solution with _____

A

Penicillins

Aminoglycosides

19
Q

List the beta-lactamase inhibitors we learned that are used to increase the activity of penicillins by blocking the breakdown of penicillinase type enzyme

A

Clavulanate
Tazobactam
Sulbactam

20
Q

Amoxicillin +/- Clavulanate

MOA
Clinical Applications

A
  1. MOA
    Amoxicillin - Inhibits cell wall peptidoglycan synthesis causing bacteria to eventually lyse

Clavulanate - Inhibits beta-lactamases

  1. Clinical Application - Community acquired pneumonia
21
Q

Piperacillin + Tazobactam

MOA
EFFECTS
CLINICAL APPLICATION

A
  1. MOA
    Piperacillin - Inhibits cell wall peptidoglycan synthesis causing bacteria to eventually lyse

Tazobactam - Inhibits beta-lactamases

  1. EFFECTS
    Active against gram +/- , aerobic/anerobic bacteria, Pseudomonas & many pathogens producing beta-lactamase
  2. CLINICAL APPLICATION
    Community acquired, hospital acquired and ventilaror associated penumonia
22
Q

____ are antibiotics grouped into 5 generations which are β-lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases. Bactericidal.

A

Cephalosporins

23
Q

List the parenteral cephalosporins discussed

A

Ceftazidime - 3rd generation
Ceftriaxone - 3rd generation
Cefepime - 4th generation

24
Q

List the oral cephalosporins discussed

A

Cefditoren - 3rd generation

Cefpodozime-proxetil - 3rd generation

25
Q

1st generation Cephalosporins

A

Cefazolin

Cephalexin

26
Q

2nd generation Cephalosporins with gram positive activity with increasing activity against gram negative bacteria

A

Cefotetan

Cefoxitin

27
Q

3rd generation Cephalosporins with increasing resistance to destruction by gram-negative beta-lactamases but less active against gram positive

A

Ceftriaxone
Cefpodoxime
Cefditoren
Ceftazidime

28
Q

4th generation Cephalosporins with quaternary ammonium, improved gram negative outer membrane penetration, active against pseudomonas

29
Q

5th generation Cephalosporins similar to ceftriaxone, but improved activity against gram positive, active against MRSA

A

Ceftaroline

30
Q

______ is given IV, noteworthy 3rd gen Cephalosporin since eliminated by both kidney and liver which often means dosage adjustment not needed for either renal or hepatic impairment (but needed if both)

A

Ceftriaxone

31
Q

______ is given IV, noteworthy 3rd gen Cephalosporin for its activity against Pseudomonas aeruginosa

A

Ceftazidime

32
Q

What Cephalosporins can cause bleeding tendencies

A 
Ceftriaxone
Cefmetzaole
Cefoperazone
Cefotetan
Cefditoren
33
Q

Ceftriaxone

  1. MOA
  2. Clinical Applications
  3. Pharmacokinetics
  4. Toxicities
A
  1. MOA
    Inhibits cell wall peptidoglycan synthesis causing bacteria to eventually lyse
  2. Inpatient treatment of COP & MANY other infections
  3. IV administration. Eliminated by both kidney & liver
  4. Beta-lactam allergy & superinfections
34
Q

Ceftazidime

  1. MOA
  2. Clinical Applications
  3. Pharmacokinetics
  4. Toxicities
A
  1. MOA
    Inhibits cell wall peptidoglycan synthesis causing bacteria to eventually lyse
  2. Inpatient treatment of COP, Lower respiratory infections including those cause by P. aeruginosa & MANY other infections
  3. IV administration. Eliminated only by kidney. Need dosage adjustment if decreased GFR
  4. Beta-lactam allergy & superinfections
35
Q

Cefpodoxime

  1. MOA
  2. Clinical Applications
  3. Pharmacokinetics
  4. Toxicities
A
  1. MOA
    Inhibits cell wall peptidoglycan synthesis causing bacteria to eventually lyse
  2. CAP, COPD, Otitis media, rhinosinusitis, Group A Strep pharyngitis, UTI, Skin & soft tissue infections
  3. ORALLY, Excreted by urine so increased activity with decreased renal function. Multiple potential drug interactions
  4. Beta-lactam allergy & superinfection
36
Q

Cefditoren

  1. MOA
  2. Clinical Applications
  3. Pharmacokinetics
  4. Toxicities
A
  1. MOA
    Inhibits cell wall peptidoglycan synthesis causing bacteria to eventually lyse
  2. CAP, Chronic bronchitis, Pharyngitis, Tonsilitis, Skin & soft tissue infections
  3. ORALLY, Excreted by urine so increased activity with decreased renal function. Multiple potential drug interactions
  4. Beta-lactam allergy, superinfection & increases INR (bleeding tendency)

CPR II - EXAM 1 & 2 (4 decks)

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